The use of immunosuppressive therapies, including methotrexate (MTX) in the psoriasis population has been associated with the formation of lymphoproliferative disorders. We present a case of a 78-year-old patient with long-standing psoriasis who developed an anaplastic cutaneous lymphoma after approximately 16 months of treatment with 15 mg per week of MTX. Within a month of diagnosis, the MTX was tapered and acitretin was started. Ten weeks later, the patient's lymphoma was clinically resolved, and his psoriasis was well controlled with acitretin and topical therapy as needed. Until further investigation in the form of large prospective clinical trials are completed to substantiate the carcinogenic risk of this antipsoriatic therapy, physicians should be made aware of this plausible association and, along with regular blood work for hepatotoxicity, careful skin screening should be conducted regularly.
SternR.S., ZierlerS., ParrishJ.Methotrexate used for psoriasis and the risk of noncutaneous or cutaneous malignancy. Cancer.1982; 50: 869–72.
2.
JeannouJ., GoupilleP., ValatJ.P.Association of methotrexate, rheumatoid arthritis, and melanoma in two patients [letter]. J Rheumatol.1997; 24: 1444–5.
3.
IshiyamaK., SuwaA., GotoM.Malignant melanoma in patients with rheumatoid arthritis [letter]. Clin Exp Rheumatol.1998; 16: 507.
4.
PotterT., HardwickN., MelherinD.Multiple malignant melanomas in patients with RA treated with methotrexate [letter]. J Rheumatol.1998; 25: 2282–3.
5.
BuchbinderR., BarberM., HeuzenroederL.Incidence of melanoma and other malignancies among rheumatoid arthritis patients treated with methotrexate. Arth Rheum.2008; 59: 794–9.
6.
KurkiP.T.Safety aspects of the long-term cyclosporine Atherapy. Scan J Rheumatol.1992; 21(suppl 95): 35–8.
7.
PennI.The problem of cancer in organ transplant recipients: an overview. Transplant Sci.1994; 4: 23–32.
8.
SloanG.M., ColeP., WilsonR.E.Risk indications of de novo malignancy in renal transplant recipients. Transplant Proc.1997; 9: 1129.
9.
CockburnI.T., KruppP.The risk of neoplasms in patients treated with cyclosporine A. J Autoimmune.1989; 2: 723–31.
10.
OlshanA.F., MattisonD.R., ZwanenburgT.S.B.Cyclosporine A: Review of genotoxicity and potential for adverse human reproductive and developmental effects. Mutat Res.1994; 317: 163–73.
11.
PaulC.F., HoV.C., McGeownC.Risk of malignancies in psoriasis patients treated with cyclosporine: a 5 y cohort study. J Invest Dermatol.2003; 120: 211–16.
12.
KurkiP.T.Safety aspects of the long-term cyclosporine A therapy. Scand J Rheumatol.1992; 21(suppl 95): 35–8.
13.
Bordes-AznarJ., MancillaE., RosenblumM.Malignant neoplasms in renal transplant patients: A 24-year experience. Transplant Proc.1992; 24: 1802–3.
14.
CardonS.B., LarsonD.F., RusselD.H.: Rapid elevation of rat serum prolactin concentration by cyclosporine, a novel immunosuppressive drug. Biochem Biophys Res Commun.1984; 120: 614.
15.
RatajcakT., MarkP.J., MartinR.L.Cyclosporine A potentiates estradiol-induced expression of the cathepsin D gene in MCF7 breast cancer cells. Biochem Biophys Res Commun.1996; 220: 208–12.
16.
GrossmanR.M., ChevretS., Abi-RechadJ.Long-term safety of cyclosporine in the treatment of psoriasis. Arch Dermatol.1996; 132: 692–4.
17.
CliffS., PettengellR., ChargeS.B-cell lymphoma developing in a patient on cyclosporine for recalcintrant psoriasis. Br J Dermatol.1999; 140: 763–5.
18.
BehnamS.M., BehnamS.E., KooJ.Y.Review of cyclosporine immunosuppressive safety data in dermatology patients after two decades of use. J Drug Dermatol.2005; 4: 189–94.
19.
KruppP., MonkaC.Side-effect profile of cyclosporine A in patients treated for psoriasis. Br J Dermatol.1990; 122: 47–56.
20.
BekkendM.W., GeelenFAMJ, van Voorst VaderP.C.Primary and secondary cutaneous CD3-+ lymphoproliferative disorders: a report from the Dutch cutaneous lymphoma group on the long-term follow-up data of 219 patients and guidelines for diagnosis and treatment. Blood.2000; 95: 3653–61.
21.
LiuH.L., HoppeR.T., KohlerS.CD30+ cutaneous lymphoproliferative disorders: the Stanford experience in lymphamatoid papulosis and primary cutaneous anaplastic large cell lymphoma. J Am Acad Dermatol.2003; 49: 1049–58.
22.
TamoszewskiM-M, MoodJ.C., LuptonG.P.Primary cutaneous Ki-1 (CD30) positive anaplastic large cell lymphoma in childhood. J AM Acad Dermatol.1999; 40: 857–61.
23.
VergierB., Beylot-BarryM., PulfordK.Statistical evaluation of diagnostic and prognostic features of CD30+ cutaneous lymphoproliferative disorders. A clinicopathologic study of 65 cases. Am J Surg Pathol.1998; 22: 1192–202.
ShehanJ.M., KalaajiA.N., MarkovicS.N.Management of multifocal primary cutaneous CD30+ anaplastic large cell lymphoma. J Am Acad Dermatol.2004; 51: 103–10.
26.
BlumeJ.E., StollH.L., CheneyR.T.Treatment of primary cutaneous lymphoma with intralesional methotrexate. J Am Acad Dermatol.2006 (letter); 54: S229–30.
27.
CorrazaM., ZampinoM.R., MontanariA.Primary cutaneous CD30+ large T-cell lymphoma in patients with psoriasis treated with cyclosporine. Dermatol.2003; 206: 330–3.
28.
CooperS.M., TurnerG.D.H., HollowoodK.Primary cutaneous large cell CD30+ lymphoma in a renal transplant patient. Br J Dermatol.2003; 149: 426–7.
PaulC., Le TourneauA., CayuelaJ.M.Epstein-Barr virus-associated lymphoproliferative disorders during methotrexate therapy for psoriasis. Arch Dermatol.1997; 133: 867–71.
34.
KhopkarU., BhorU.Hodgkin's lymphoma in a patient of psoriasis treated with long-term, low-dose methotrexate therapy. Indian J Dermatol Venereol Leprol.2008; 74: 379–82.
35.
SuzukiM., HiranoS., ItoH.Pulmonary lymphoma developed during long-term methotrexate therapy for psoriasis. Respirology.2007; 12: 774–6.
36.
KamelO.W.Lymphomas during long-term methotrexate therapy. Arch Dermatol.1997; 133: 903–4.
