mercaptopurine and Skin-Neoplasms

The thiopurines are effective in the management of patients with inflammatory bowel disease (IBD), but the association between thiopurines use and the risk of skin cancer (including nonmelanoma skin cancer [NMSC] and melanoma skin cancer) has already been sufficiently reported. However, the results of these studies are inconsistent, and thus, the objective of our analysis was to explore whether thiopurines can lead to an excess risk of skin cancer in IBD patients.. MEDLINE, EMBASE, and the Cochrane Library were searched to identify relevant studies that evaluated the risk of skin cancer in IBD patients treated with thiopurines. A random effects meta-analysis was conducted to calculate the pooled incidence rate ratios as well as risk ratios (RRs). Subgroup analysis was performed to explore the potential source of heterogeneity.. Thirteen studies comprising 149 198 participants were included. The result suggested that thiopurines significantly increased the risk of overall skin cancer in IBD patients (random effects: RR = 1.80, 95% confidence interval [CI] 1.14-2.87, P = 0.013), among which NMSC showed an excess risk associated with thiopurines use (random effects: RR = 1.88, 95% CI 1.48-2.38, P < 0.001) while no increased risk was observed with respect to melanoma skin cancer (random effects: RR = 1.22, 95% CI 0.90-1.65, P = 0.206). Subgroup analysis regarding sample size and geographic distribution in skin cancer and follow-up duration in NMSC reached statistical significance, while other subgroups showed no significance.. Exposition of thiopurines in patients with IBD is associated with a higher risk of skin cancer. Routine skin screening and daily skin protective practice are recommended for these patients.

Topics: Azathioprine; Databases, Bibliographic; Humans; Inflammatory Bowel Diseases; Melanoma; Mercaptopurine; Risk; Skin Neoplasms

Azathioprine and 6-mercaptopurine (thiopurines) are common adjunct treatments for inflammatory bowel disease (IBD). Although thiopurine therapy in organ transplant recipients is known to increase nonmelanoma skin cancers (NMSCs), dermatologic literature yields less data regarding NMSC risk of thiopurine use in IBD.. The aim of this study was to systematically review current literature on NMSC risk in patients with IBD using thiopurine therapy.. Systematic review of PubMed was performed with keywords "inflammatory bowel disease," "ulcerative colitis," "Crohn's disease," "thiopurine," "azathioprine," "6-mercaptopurine," "skin cancer," "non-melanoma," "squamous cell carcinoma," and "basal cell carcinoma." All available publication years were included. Publications were evaluated using PRISMA guidelines.. The systematic review yielded 67 articles; 18 met final inclusion criteria.. Heterogeneity of study designs limited direct comparisons of thiopurine exposure and NMSC risk.. Patients with IBD using thiopurines seem to have a moderately increased risk of NMSC that is proportional to therapy duration. Risk of NMSC seems to decrease or return to baseline after discontinuing therapy, although additional data are needed to support this trend. Younger patients with IBD using thiopurines seem to be at greater risk of NMSC. Appreciating NMSC risk in patients with IBD undergoing thiopurine therapy should help direct skin cancer screening recommendations and sun protective measures.

Topics: Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Mercaptopurine; Skin Neoplasms

Crohn's disease (CD) is a chronic inflammatory disease that confers a higher risk of cancer than in the general population. New, large, population-based studies in the past decade show that patients with CD are at higher risk of colorectal, small bowel, melanoma, and cervical cancer. Patients who use thiopurines are at additional risk of development of lymphoma and nonmelanoma skin cancer. Preventive surveillance for cancers of the colorectum, skin, and uterine cervix is advised.

Topics: Colorectal Neoplasms; Crohn Disease; Early Detection of Cancer; Female; Humans; Immunosuppressive Agents; Intestinal Neoplasms; Intestine, Small; Lymphoma; Male; Melanoma; Mercaptopurine; Risk Factors; Skin Neoplasms; Uterine Cervical Neoplasms

Immunosuppressive agents and biological agents are widely used for therapy in patients with inflammatory bowel disease (IBD). However, these therapies may be associated with an increased risk of malignancy. There is evidence that exposure of the therapeutic agents such as thiopurine and anti-tumor necrosis factor for IBD is associated with an increased risk of lymphoproliferative disorders, skin cancers, or uterine cervical cancers. This article reviews the malignancies associated with the use of immunosuppressive agents and biological agents in IBD.

Topics: Adalimumab; Azathioprine; Biological Factors; Female; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Intestinal Neoplasms; Lymphoproliferative Disorders; Mercaptopurine; Risk Factors; Skin Neoplasms

Cancer may be a complication of inflammatory bowel disease (IBD) or its treatments. In older Crohn's disease and ulcerative colitis patients, the risk of malignancy is of particular concern. IBD diagnosis at an advanced age is associated with earlier development of colitis-associated colorectal cancer. Thiopurine use in older IBD patients is tied to an increased risk of non-Hodgkin's lymphoma, nonmelanoma skin cancer, and urinary tract cancers. Additionally, older age is accompanied by multimorbidity, an increased risk of malnutrition, and decreased life expectancy, factors that complicate the management of cancer in the elderly. The optimal approach to the increased risk of malignancy in older age IBD is appropriate cancer screening and medical treatment. This may include age-specific colorectal cancer screening and limiting UV radiation exposure. With a growing number of older IBD patients, further studies are necessary to delineate the risk of cancer in this population.

Topics: Age Factors; Aged; Colorectal Neoplasms; Early Detection of Cancer; Humans; Inflammatory Bowel Diseases; Lymphoma, Non-Hodgkin; Mercaptopurine; Skin Neoplasms; Urologic Neoplasms

Thiopurines are the mainstay of treatment for patients with inflammatory bowel disease (IBD). Thiopurine therapy increases the risk of nonmelanoma skin cancers (NMSCs) in organ transplant patients. The data on NMSC in patients with IBD on thiopurines is conflicting.. We searched electronic databases for full journal articles reporting on the risk of developing NMSC in patients with IBD on thiopurine and hand searched the reference lists of all retrieved articles. Pooled adjusted hazard ratios and 95% confidence intervals (CIs) were determined using a random-effects model. Publication bias was assessed using Funnel plots and Egger's test. Heterogeneity was assessed using Cochran's Q and the I(2) statistic.. Eight studies involving 60,351 patients provided data on the risk of developing NMSC in patients with IBD on thiopurines. The pooled adjusted hazards ratio of developing NMSC after exposure to thiopurines in patients with IBD was 2.28 (95% CI: 1.50 to 3.45). There was significant heterogeneity (I(2)=76%) between the studies but no evidence of publication bias. Meta regression analysis suggested that the population studied (hospital-based vs. population-based) and duration of follow-up contributed significantly to heterogeneity. Grouping studies based on population studied and duration showed higher hazard rations in hospital-based and shorter duration studies.. The risk of developing NMSC in patients with IBD on thiopurines is only modestly elevated. The difference in pooled risk between population-based and hospital-based studies suggests the possibility that ascertainment bias could have contributed to this increased risk.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cohort Studies; Confidence Intervals; Databases, Factual; Education, Medical, Continuing; Female; Humans; Immunosuppressive Agents; Incidence; Inflammatory Bowel Diseases; Male; Mercaptopurine; Prognosis; Proportional Hazards Models; Regression Analysis; Risk Assessment; Skin Neoplasms; United Kingdom

The thiopurines azathioprine, 6-mercaptopurine and 6-thioguanine (6-TG) are important medications for cancer and inflammatory disorders. They are also widely prescribed as immunosuppressants in organ transplant patients. Their metabolism results in the incorporation of 6-TG into patients' DNA, and this increases skin sensitivity to incident UVA. Unlike the canonical DNA bases, which do not absorb UVA to a significant degree, DNA 6-TG is a strong UVA chromophore. It acts as a Type II UVA photosensitizer, and the combination of 6-TG and UVA treatment induces a synergistic toxicity in cultured human cells. Here, we review some of the damage that this interaction causes. Photochemical activation of DNA 6-TG triggers DNA and protein oxidation; it induces DNA breakage, DNA crosslinking, oxidation of DNA bases and the covalent attachment of proteins to DNA. Many of these photochemical DNA lesions are difficult for cells to deal with, and we review the evidence linking thiopurine immunosuppression with genome instability and the high incidence of skin cancer in organ transplant recipients.

Topics: Azathioprine; Humans; Immunosuppressive Agents; Mercaptopurine; Photosensitizing Agents; Skin Neoplasms; Thioguanine; Ultraviolet Rays

Topics: Aged; Antigens, CD; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bone Marrow; Bone Marrow Transplantation; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Daunorubicin; Dendritic Cells; Disease Progression; Doxorubicin; Humans; Immunophenotyping; Leukemia, Myelomonocytic, Acute; Lymph Nodes; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Methotrexate; Middle Aged; Prednisone; Prognosis; Remission Induction; Skin Neoplasms; Transplantation, Homologous; Vincristine

Recently, rare CD4+/CD56+ hematodermic neoplasm has been described as a distinct clinico-pathologic entity, with aggressive course and poor outcome. Skin is typically involved at presentation, but widespread dissemination to bone marrow is rapid. To date, no standardized therapeutic approach to this disease has been established. As its diffusion mainly concerns elderly patients, only a few paediatric cases have been documented. We report an additional case of CD4+/CD56+ hematodermic tumour that showed a good response to chemotherapy based on a lymphoma protocol. Moreover, we try to analyse features and outcome of a few other paediatric CD4+/CD56+ hematodermic tumours as they are reported in the literature.

Topics: Antineoplastic Combined Chemotherapy Protocols; Asparaginase; CD4 Antigens; CD56 Antigen; Child; Cyclophosphamide; Cytarabine; Daunorubicin; Dendritic Cells; Dexamethasone; Humans; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Methotrexate; Prednisone; Remission Induction; Skin Neoplasms; Vincristine

Topics: Animals; Antineoplastic Agents; Azathioprine; Azauridine; Bleomycin; Chlorambucil; Cyclophosphamide; Cytarabine; Dactinomycin; Humans; Hydroxyurea; Immunosuppressive Agents; Mercaptopurine; Methotrexate; Procarbazine; Skin Diseases; Skin Neoplasms; Vinblastine; Vincristine

Topics: Animals; Animals, Newborn; Antilymphocyte Serum; Antimetabolites; Azathioprine; Carcinogens; Cell Division; Graft vs Host Reaction; Histocompatibility Antigens; Humans; Immunity, Cellular; Immunosuppression Therapy; Immunosuppressive Agents; Lymphoma; Mercaptopurine; Mice; Mice, Inbred C57BL; Mice, Inbred NZB; Oncogenic Viruses; Procarbazine; Skin Neoplasms; Thymectomy

Thiopurines are widely used to maintain remission in both ulcerative colitis (UC) and Crohn's disease (CD). Reported effectiveness and tolerability rates have been variable across studies. There are only sparse data in Asian population regarding the long-term efficacy and safety of thiopurines.. Records of 5351 patients followed up at inflammatory bowel disease (IBD) clinic, All India Institute of Medical Sciences, New Delhi from 2004 to 2020 were evaluated retrospectively. Safety was evaluated in terms of long-term adverse events and development of malignancy.. Of 5351 patients with IBD, 1093 who received thiopurine for > 3 months (UC = 788 [proctitis-1.9%, left-sided colitis-44.9%, & pancolitis-53.1%] & CD = 305 [inflammatory-42.6%, stricturing-46.9%, & fistulizing-10.5%]) were included (60.8%-male patients). Follow up and treatment duration on thiopurine were 7 (4-12) years and 39.4 ± 40.3 months, respectively, with 254 (23.2%) patients receiving thiopurines for more than 5 and 68 (6.2%) receiving for more than 10 years. Three hundred and fifty-nine (UC: 249 [31.6%]; CD: 110 [36.1%]; P = 0.1) patients developed adverse events; commonest was myelosuppression (23.4%) followed by gastrointestinal intolerance (3%), flu-like illness (1.7%), and arthralgia/myalgia (1.4%). Myelosuppression was the commonest cause of thiopurine withdrawal. No patient (including 254 patients on thiopurine for ≥ 5 years) developed lymphoma or non-melanoma skin cancer. The cumulative probability of staying free from adverse events in overall IBD cohort at 1, 2, and 5 years was 78.6%, 71.9%, and 68.4%, respectively, and this was comparable between UC and CD (P = 0.09).. Long-term follow up of patients with IBD from northern India on thiopurine monotherapy demonstrated minimal risk of development of lymphoma as well as non-melanoma skin cancer.

Topics: Azathioprine; Cohort Studies; Colitis, Ulcerative; Crohn Disease; Humans; India; Inflammatory Bowel Diseases; Lymphoma; Male; Mercaptopurine; Retrospective Studies; Risk Factors; Skin Neoplasms

Patients with inflammatory bowel diseases may have higher incidences of non-melanoma skin cancers and non-Hodgkin lymphoma, potentially linked to underlying disease and treatments. This analysis assessed incidence rates of these malignancies in Japanese patients with ulcerative colitis or Crohn's disease, and their association with thiopurine and/or anti-tumor necrosis factor-α treatment, using data from a nationwide administrative database in Japan.. Patients diagnosed with inflammatory bowel disease without malignancy were identified from the Medical Data Vision database. Incident cases of non-melanoma skin cancers and non-Hodgkin lymphoma diagnosed after prescription of thiopurine and/or anti-tumor necrosis factor-α were identified between April 2008 and January 2018. Age- and sex-adjusted incidence rate ratios were calculated relative to the total treated patient population.. A total of 75 673 eligible patients were identified at the index date. Thiopurine prescription with or without anti-tumor necrosis factor-α agents increased incidence rate ratios for non-melanoma skin cancers relative to the overall population (3.39 and 4.03, respectively). There were no notable differences in non-Hodgkin lymphoma incidence relative to the total population in any treatment subgroup, regardless of prescription of thiopurine and/or anti-tumor necrosis factor-α (all incidence rate ratios, ~1).. There is no evidence for an increased incidence of non-Hodgkin lymphoma attributable to thiopurine or anti-tumor necrosis factor-α treatment in Japanese patients with inflammatory bowel disease. The impact of racial differences on non-Hodgkin lymphoma incidences should be considered. Thiopurine therapy may be a risk factor for non-melanoma skin cancers in Japanese patients.

Topics: Adalimumab; Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Colitis, Ulcerative; Crohn Disease; Cross-Sectional Studies; Databases, Factual; Drug Therapy, Combination; Female; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Incidence; Infliximab; Japan; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Middle Aged; Proportional Hazards Models; Risk Factors; Skin Neoplasms; Tumor Necrosis Factor-alpha

New Zealand (NZ) has one of the highest rates of non-melanoma skin cancers (NMSCs) in the world. Thiopurine use in inflammatory bowel disease (IBD) patients has been shown to increase NMSC risk. This study aimed to investigate the possible increase of NMSC risk in thiopurine-treated IBD patients in NZ despite the high background rate.. Inflammatory bowel disease patients treated with thiopurines and healthy controls were recruited across two different latitude centers in NZ. Consented participants completed a questionnaire to identify additional risk factors and were examined for suspicious skin lesions. These were photographed, and the pictures were evaluated by a dermatologist. Data were compared between centers and between groups with NMSC incidence and thiopurine-associated relative risks estimated.. One hundred seventy-one thiopurine-exposed IBD patients and 201 controls were recruited. Twenty seven of 390 photographs (26 participants) showed suspicious lesions (17 exposed, 9 controls) as determined by the dermatologist. Estimated NMSC incidence was 24.7-34.3/1000 patient-years (thiopurine-exposed, depending on classification of unconfirmed suspicious lesions) and 7-14/1000 patient-years (control). The relative risk of NMSC among thiopurine exposed was 2.38-2.97 (P ≤ 0.014), which remained significant after individually adjusting for potential confounders. We estimated the NMSC risk to increase 5.4-6.6% per 6 months of thiopurine use (P < 0.001). Low compliance in avoiding NMSC risk factors in the exposed group was observed.. We found a twofold to threefold increase in NMSC incidence in IBD patients treated with thiopurines in NZ, despite the high background incidence rate.

Topics: Adolescent; Adult; Aged; Female; Humans; Immunosuppressive Agents; Incidence; Inflammatory Bowel Diseases; Male; Mercaptopurine; Middle Aged; New Zealand; Risk; Risk Factors; Skin Neoplasms; Surveys and Questionnaires; Young Adult

Topics: Antimetabolites; Colitis, Ulcerative; Female; Humans; Male; Melanoma; Mercaptopurine; Skin Neoplasms

There are limited data on the risk of non-melanoma skin cancer (NMSC) and melanoma skin cancer (MSC) among thiopurine-treated patients with ulcerative colitis (UC). Our aim was to investigate the risk while on, by cumulative years, and after stopping thiopurine therapy.. Nationwide data were obtained from the Veterans Affairs (VA) health-care system during 2001-2011. We performed a retrospective cohort study evaluating patients with UC. Cox regression was used to investigate the association between thiopurines use and time to NMSC while adjusting for demographics, ultraviolet radiation exposure, and VA visiting frequency. A matched nested case-control study was conducted to investigate the association between thiopurine use and MSC.. We included 14,527 patients with UC in the analysis, with a median follow-up of 8.1 years. A total of 3,346 (23%) patients used thiopurines for a median duration of 1.6 years. We identified 421 NMSC and 45 MSC cases. The adjusted hazard ratios of developing NMSC while on and after stopping thiopurines were 2.1 (P<0.0001) and 0.7 (P=0.07), respectively, as compared with unexposed patients. The incidence rate of NMSC among those who never used thiopurines was 3.7 compared with 5.8, 7.9, 8.3, 7.8, and 13.6 per 1,000 person-years for the 1st, 2nd, 3th, 4th, and 5th year of thiopurine use, respectively. No statistically significant association was observed between thiopurine use and MSC, odds ratio 0.8 (P=0.6).. In this predominantly white male nationwide cohort, there was a twofold increase in the risk of NMSC while on thiopurines. The incidence rate of NMSC significantly increased with subsequent years of cumulative exposure to thiopurines. Stopping thiopurines reduced the risk of NMSC to pre-exposure levels irrespective of the prior exposure duration.

Topics: Aged; Antimetabolites; Colitis, Ulcerative; Female; Humans; Incidence; Male; Melanoma; Melanoma, Cutaneous Malignant; Mercaptopurine; Middle Aged; Regression Analysis; Retrospective Studies; Risk; Skin Neoplasms; United States; Veterans

Herein, we report the first case of kaposiform haemangioendothelioma (KHE) associated with acute B-lymphoblastic leukemia (B-ALL).. A five-month-old infant presented a plaque of angiomatous appearance on the forearm that had increased in volume since birth, as well as pallor and cutaneous haematomas. Kasabach-Merritt syndrome (KMS) was evoked despite hepatomegaly and considerable splenomegaly. Laboratory tests revealed severe anaemia and thrombocytopenia as well as major hyperleukocytosis with 90% blasts. Skin biopsy revealed vast vascular lobules containing cohesive fusiform endothelial cells not expressing Glut1, bound up in a dense infiltrate of B-lymphoblast cells. It was in fact KHE associated with B-ALL confirmed by the myelogram. The child was treated with the INTERFANT 2006 protocol followed by allograft of haematopoietic stem cells, which resulted in complete haematological remission. At the same time, almost total regression of KHE was noted.. In this infant, KHE had an inflammatory appearance and was associated with thrombocytopenia, evocative of KMS. Analysis of blood and marrow samples resulted in a diagnosis of B-ALL. Histopathological examination of the angioma revealed a typical appearance of KHE associated with dense lymphoblastic proliferation. This appearance could have resulted either from passive contamination by circulating blast cells or from active recruitment of tumor cells at the KHE site.. HK mimicking KMS may reveal B-ALL.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Biopsy; Combined Modality Therapy; Cord Blood Stem Cell Transplantation; Cyclophosphamide; Cytarabine; Diagnostic Errors; Hemangioendothelioma; Hemangioma; Humans; Infant, Newborn; Kasabach-Merritt Syndrome; Leukemia, B-Cell; Male; Mercaptopurine; Methotrexate; Neoplasms, Multiple Primary; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Remission Induction; Skin Neoplasms; Transplantation, Homologous

The thiopurines azathioprine and 6-mercaptopurine are effective in the management of patients with inflammatory bowel disease (IBD) in whom aminosalicylates, antibiotics and corticosteroids have failed to induce or maintain remission. Long-term use of these agents has been linked to a greatly increased risk of non-melanoma skin cancer and lymphatic cancer in organ transplant recipients. There is some evidence to suggest that IBD patients receiving thiopurines might be at increased risk of cancer. Our aim was to determine the incidence of cancer in a cohort of patients with IBD managed in our clinic, and to relate this to thiopurine exposure.. We conducted a retrospective study based on the clinical and pathology records of patients attending a specialist IBD clinic at Groote Schuur Hospital, Cape Town, South Africa between 1960 and 2007.. We analyzed the records of 1084 patients. A total of 123 subjects (11.5%) had received thiopurine therapy. Cancer was identified in 51 patients (4.7%), including colorectal cancer (15 patients), melanoma (two patients), non-melanoma skin cancer (seven patients) and non-Hodgkin's lymphoma (five patients). A diagnosis of non-melanoma skin cancer was significantly associated with thiopurine exposure (odds ratio 5.0, 95% confidence interval 1.1-22.8). Six of seven non-melanoma skin cancers occurred in Caucasian patients, with a highly significant association with thiopurine use (odds ratio 12.4, 95% confidence interval 2.3-67.4).. Patients with IBD who receive thiopurines are at increased risk of non-melanoma skin cancer. The risk is highest in Caucasian patients, and is negligible in other groups.

Topics: Adult; Anti-Inflammatory Agents; Azathioprine; Female; Gastrointestinal Agents; Humans; Incidence; Inflammatory Bowel Diseases; Male; Mercaptopurine; Middle Aged; Odds Ratio; Retrospective Studies; Risk Assessment; Risk Factors; Skin Neoplasms; Skin Pigmentation; South Africa; Sunlight; Time Factors; White People; Young Adult

Topics: Anti-Inflammatory Agents; Azathioprine; Female; Gastrointestinal Agents; Humans; Inflammatory Bowel Diseases; Male; Mercaptopurine; Skin Neoplasms

Patients with inflammatory bowel disease (IBD) are at risk for certain malignancies. We aimed to determine the risk of melanoma and nonmelanoma skin cancer (NMSC) in patients with IBD and how medications affect these risks.. We performed retrospective cohort and nested case-control studies using administrative data from the LifeLink Health Plan Claims Database from 1997 to 2009. The cohort comprised 108,579 patients with IBD, and each was matched to 4 individuals without IBD. The risk of melanoma and NMSC was evaluated by incidence rate ratio (IRR) and by adjusted Cox proportional hazard ratio (HR) modeling. In nested case-control studies, patients with melanoma or NMSC were matched to 4 patients with IBD without melanoma or NMSC. Conditional logistic regression was used to determine associations between medications and both skin cancers.. In the cohort, IBD was associated with an increased incidence of melanoma (IRR, 1.29; 95% confidence interval [CI], 1.09-1.53). Risk was greatest among individuals with Crohn's disease (IRR, 1.45; 95% CI, 1.13-1.85; adjusted HR, 1.28; 95% CI, 1.00-1.64). The incidence of NMSC also increased among patients with IBD (IRR, 1.46; 95% CI, 1.40-1.53) and was greatest among those with CD (IRR, 1.64; 95% CI, 1.54-1.74). In the nested case-control studies, therapy with biologics increased the risk of melanoma (odds ratio [OR], 1.88; 95% CI, 1.08-3.29). Patients who had been treated with thiopurines had an increased risk of NMSC (OR, 1.85; 95% CI, 1.66-2.05).. Immunosuppression increases the risk of melanoma and NMSC among patients with IBD. The risk of melanoma is increased by use of biologics, and the risk of NMSC is increased by use of thiopurines. Patients with IBD should be counseled and monitored for skin cancer.

Topics: Adult; Antibodies, Monoclonal, Humanized; Case-Control Studies; Cohort Studies; Female; Humans; Immunosuppressive Agents; Incidence; Inflammatory Bowel Diseases; Logistic Models; Male; Melanoma; Mercaptopurine; Middle Aged; Proportional Hazards Models; Retrospective Studies; Risk; Skin Neoplasms; Tumor Necrosis Factor-alpha; United States

Topics: Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Melanoma; Mercaptopurine; Prospective Studies; Skin Neoplasms

Immunosuppressant medications for Inflammatory Bowel Disease can help with both symptoms and disease progression. However, like immunosuppressants used in transplant patients, they are now suspect of contributing to nonmelenoma skin cancer (NMSC). Presented is a case of a 57-year-old Jewish man with Crohn's Disease who was diagnosed with a total of 84 NMSCs. We hope to elucidate the risk of immunosuppressants, particularly the thiopurines, on the development of NMSC.

Topics: Adenocarcinoma; Crohn Disease; Fatal Outcome; Hawaii; Humans; Immunosuppressive Agents; Intestinal Neoplasms; Male; Mercaptopurine; Middle Aged; Skin Neoplasms; Sunlight

Topics: Antibodies, Monoclonal; Crohn Disease; Drug Therapy, Combination; Female; Hand; Humans; Immunosuppressive Agents; Infliximab; Mercaptopurine; Nevus, Pigmented; Skin Neoplasms; Young Adult

Topics: Female; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Male; Mercaptopurine; Risk Assessment; Skin Neoplasms

Clinically diagnosed metastasis to the thyroid gland is exceptionally rare and may present diagnostic issues on fine needle aspiration. The most common primary sites of metastases to the thyroid are cancers of the lung, breast, skin (especially melanoma), colon, and kidney. Herein, we report a case of metastatic Merkel cell carcinoma to the thyroid presenting as a 2.1-cm solid nodule in a 50-year-old male with a previous history of Merkel cell carcinoma of the upper extremity. The aspirates were moderately to highly cellular featuring small to intermediate sized cells with scant to no cytoplasm, round-to-oval nuclei with finely dispersed chromatin, and predominantly arranged as scattered single cells. There was focal nuclear molding, numerous mitoses, and karyorrhectic nuclei. The differential diagnosis centered on the "small round blue cell" tumor group such as medullary thyroid carcinoma and non-Hodgkin lymphoma. However, in light of our patient's previous history, the FNA findings were most consistent with a metastasis of Merkel cell carcinoma. In patients with a known history of a primary neoplasm, the differential diagnosis of a thyroid nodule should always include potential metastasis.

Topics: Biopsy, Fine-Needle; Carcinoma, Merkel Cell; Carcinoma, Small Cell; Crohn Disease; Diagnosis, Differential; Fibrosis; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Skin Neoplasms; Thyroid Neoplasms

The correlation between combined chemotherapy, including 6-mercaptopurine, and development of excessive number of melanocytic nevi in childhood has been previously reported and studied. As of yet, no such relation has been reported in adults. We recently observed a 27-year-old female patient who developed numerous benign melanocytic nevi during a 20-month period while taking 6-mercaptopurine for Crohn's disease. The appearance of many nevi was worrisome to the patient from a cosmetic and medical perspective (given the higher risk of melanoma associated with large numbers of nevi).

Topics: Adult; Crohn Disease; Drug Eruptions; Female; Humans; Immunosuppressive Agents; Mercaptopurine; Nevus, Pigmented; Skin Neoplasms

A 67-year-old patient with chronic myeloid leukemia for 4 years rapidly developed multiple squamous-cell carcinomas on the scalp. We discuss the role of chemotherapy, chronic immunosuppression, chronic sun exposure and of possible genetic factors.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Carcinoma, Squamous Cell; Humans; Hydroxyurea; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Mercaptopurine; Neoplasms, Multiple Primary; Scalp; Skin Neoplasms; Sunlight

Multiple melanocytic nevi showing an unusual accumulation on the soles of the feet were observed in an 8-year-old boy after he had received chemotherapy for acute lymphatic leukemia. This observation confirms the occurrence of chemically induced melanocytic nevi as well as their affinity for the acral sites.

Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Foot Diseases; Humans; Male; Mercaptopurine; Methotrexate; Nevus, Pigmented; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Skin Neoplasms

The authors treated the apigmented melanoma IC-Sofia in hamster with various doses of the following cytostatics: Cyclophosphamide, 6-Mercaptopurine, Vinblastine and Actinomycin D for 7 consecutive days. Determination of the tumor growth inhibition on the 8th day (early test) on the basis of tumor weight in the animals treated and untreated with cytostatics indicates that the tumor used is more sensitive to the effect of Cyclophosphamide and 6-MP and less to Vinblastine and Actinomycin D. Nevertheless sensitivity to cytostatic action is high enough for each of the cytostatic agents, depending upon the applied dose. This gives grounds to the authors to assume that hamster apigmented melanoma IC-Sofia is an adequate model for testing and evaluation of antitumor drugs.

Topics: Animals; Antineoplastic Agents; Cricetinae; Cyclophosphamide; Dactinomycin; Drug Evaluation, Preclinical; Melanoma; Mercaptopurine; Neoplasms, Experimental; Skin Neoplasms; Vinblastine

The carcinogenic effect of ultraviolet radiation (UVR) on the skin of hairless (hr) mice was modified by two immunosuppressive agents, rabbit anti-mouse lymphocytic serum (ALS), and 6-mercaptopurine (6MP). Daily exposure of mice to UVR resulted in multiple tumor production. Carcinogenesis was measured in terms of affected mice (prevalence) and numbers of tumors produced. By both criteria, photocarcinogenesis was enhanced by ALS but inhibited by 6MP.

Topics: Animals; Antilymphocyte Serum; Immunosuppressive Agents; Male; Mercaptopurine; Mice; Mice, Nude; Neoplasms, Experimental; Neoplasms, Radiation-Induced; Skin Neoplasms; Ultraviolet Rays

Topics: Bone Neoplasms; Child, Preschool; Cyclophosphamide; Female; Ganglioneuroma; Humans; Infant; Mercaptopurine; Neoplasm Metastasis; Neuroblastoma; Prednisone; Skin Neoplasms; Vincristine

Reticulosarcoma-like skin lesions are described in a boy with phenylketonuria (PKU) who was observed for 11 years. Association of the lesions with PKU is indicated by their dependence on the severity of the latter and their complete healing during treatment with low phenylalanine diet.

Topics: Biopsy; Child; Child, Preschool; Humans; Infant; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Phenylketonurias; Prednisolone; Skin; Skin Manifestations; Skin Neoplasms

Topics: Acute Disease; Adult; Humans; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Prednisolone; Skin Neoplasms

Topics: Anemia, Aplastic; Azathioprine; Cyclophosphamide; Hemangiosarcoma; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Skin Neoplasms; Thymoma; Thymus Gland; Thymus Neoplasms

Topics: Antineoplastic Agents; Azathioprine; Condylomata Acuminata; Fluorouracil; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mercaptopurine; Methotrexate; Papilloma; Pemphigus; Precancerous Conditions; Psoriasis; Scleroderma, Systemic; Skin Diseases; Skin Neoplasms; Virus Diseases

Topics: Alkylating Agents; Animals; Antimetabolites; Antineoplastic Agents; Benz(a)Anthracenes; Busulfan; Carcinoma, Squamous Cell; Chlorambucil; Cortisone; Cyclophosphamide; Dactinomycin; Estradiol; Female; Fluorouracil; Hydroxyurea; Mercaptopurine; Methotrexate; Mice; Mitomycins; Neoplasms, Experimental; Nitrogen Mustard Compounds; Nitroso Compounds; Papilloma; Skin Neoplasms; Testosterone; Triethylenemelamine

Topics: Animals; Antibody Formation; Blood Chemical Analysis; Cortisone; Fibroma; Lagomorpha; Mercaptopurine; Necrosis; Oncogenic Viruses; Rabbits; Research; Skin Neoplasms; Tumor Virus Infections