title: Exposure to phototoxic NSAIDs and quinolones is associated with an increased risk of melanoma.
abstract: OBJECTIVE
  Ultraviolet radiation exposure is the most important exogenous risk factor for cutaneous malignancies. It is possible that phototoxic drugs promote the development of cutaneous melanoma (CM) by intensifying the effect of ultraviolet light on the skin. We investigated the association between the use of common systemic phototoxic drugs and development of CM.
  
  
  METHODS
  This study was a case-control study in a Dutch population-based cohort. The drug dispensing data was obtained from PHARMO, a Dutch drug dispensing and hospital admissions registry, and linked to PALGA, the nationwide pathology network of the Netherlands. The cases were patients diagnosed with pathologically confirmed primary CM between 1991 and 2004. Controls were sampled from the PHARMO population. Exposure to systemic phototoxic drugs was measured and included antimicrobial agents, diuretics, antipsychotic drugs, antidiabetic drugs, cardiac drugs, antimalarials and nonsteroidal anti-inflammatory drugs (NSAIDs). A multivariate conditional logistic regression analysis was performed to study the association between exposure to phototoxic drugs and CM.
  
  
  RESULTS
  The study population included 1,318 cases and 6,786 controls. Any phototoxic drug during the study period was dispensed for 46 % of the cases and 43 % of the controls (p = 0.012). The use of quinolones [odds ratio (OR) 1.33, 95 % confidence interval (CI) 1.01-1.76] and propionic acid derivative NSAIDs (OR 1.33, 95 % CI 1.14-1.54) had a positive association with CM.
  
  
  CONCLUSIONS
  Our study shows that the use of phototoxic drugs is associated with an increased risk of developing CM. Even a short-term use of phototoxic quinolones and propionic acid derivative NSAIDs may increase the risk for CM. Patient education to promote sun-protective behaviour is essential to avoid immediate adverse effects and possible long-term effects of phototoxic drugs.
authors.affiliation: Department of Dermatology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Satu J
authors.initials: SJ
authors.lastname: Siiskonen
authors.forename: Els R
authors.initials: ER
authors.lastname: Koomen
authors.forename: Loes E
authors.initials: LE
authors.lastname: Visser
authors.forename: Ron M C
authors.initials: RM
authors.lastname: Herings
authors.forename: Henk-Jan
authors.initials: HJ
authors.lastname: Guchelaar
authors.forename: Bruno H Ch
authors.initials: BH
authors.lastname: Stricker
authors.forename: Tamar E C
authors.initials: TE
authors.lastname: Nijsten
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000528:radiation effects; D016022:Case-Control Studies; D015331:Cohort Studies; D016208:Databases, Factual; D017484:Dermatitis, Phototoxic / Q000503:physiopathology*; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011422:Propionates / Q000009:adverse effects / Q000528:radiation effects; D011446:Prospective Studies; D015363:Quinolones / Q000009:adverse effects* / Q000528:radiation effects; D012042:Registries; D012306:Risk; D012867:Skin / Q000187:drug effects* / Q000528:radiation effects; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D011422:Propionates; D015363:Quinolones