HUMAN PAPILLOMAVIRUS AND WIDESPREAD CUTANEOUS CARCINOMA AFTER PUVA PHOTOCHEMOTHERAPY

Background: Oral psoralen with UV-A (PUVA) photochemotherapy is known to cause cutaneous malignancies and has been associated with cutaneous immunosuppression. Human papillomavirus infection has also been assoc iated with cutaneous malignancies and with immunosuppressed individual s. We therefore sought evidence of human papillomavirus infection in a patient with a long history of PUVA therapy and multiple cutaneous ma lignancies. Observations: During a 15-year period, an otherwise health y patient with psoriasis who had undergone a 10-year course of PUVA ph otochemotherapy developed 13 squamous cell carcinomas, eight lesions d iagnosed as ''squamous cell carcinoma vs keratoacanthoma,'' 14 other k eratoacanthomas, six basal cell carcinomas, one melanoma in situ; and 18 other keratinocytic dysplasias. Twenty-two of the 30 lesions tested for human papillomavirus DNA by polymerase chain reaction were positi ve for type 16/18, including six of the seven basal or squamous cell c arcinomas tested. Conclusion: We hypothesize that PUVA therapy-induced immunosuppression may play an important role in PUVA-related carcinog enesis by affecting the extent and pathogenicity of human papillomavir us infection.