Poster Presentation Australasian Society for Dermatology Research Annual Scientific Meeting 2024

Eruptive squamous cell carcinomas development on Apremilast (#81)

Natasha Abeysekera 1 , Justin Holland 2 , Christina Sander 2
  1. Dermatology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
  2. Central Dermatology Clinic, Maroochydore, QLD, Australia

Introduction:

Patients with psoriasis have a higher incidence of keratinocyte cancers; with risk factors including photochemotherapy and ciclosporin. Unlike methotrexate and other biological medications, the use of apremilast for psoriasis in patients with malignancy is not contraindicated.

Methods:

We report two cases of eruptive squamous cell carcinoma(SCC) and keratoacanthoma(KA) development shortly after commencing apremilast in patients with psoriasis.

Findings:

Patient A had rapid SCC development despite recommencing acitretin whilst on apremilast. Patient B underwent nbUVB therapy throughout her treatment for psoriasis, with no SCC development except during concomitant therapy with apremilast. Neither patient developed further rapidly progressing SCCs after being commenced on risankizumab for their psoriasis.

The role of psoriasis severity on the rapid development of SCCs amongst our patients cannot be discount; as although both patients had severe psoriasis prior to commencing apremilast with a lower incidence of SCCs, they had flares of their condition prior to cessation of apremilast. A recent study noted a shorter time to first keratinocyte cancer amongst those with psoriasis than rheumatoid arthritis whilst on TNF inhibitors, suggesting this was due to phototherapy and other disease-related factors. Comparatively in our patients, phototherapy did not appear to affect the development of SCCs.

Research has suggested an association with ‘rebound’ SCC development during interruption of acitretin therapy in organ-transplant recipients. A retrospective study noted six patients with organ-transplants had interruptions of acitretin therapy, ranging from 3 to 6 months, had a mean increase of 4.67 SCCs in the 12 months post-interruption. Patient A did have an interruption to acitretin therapy of 3 months, with 4 SCCs in the 12 months pre-interruption and 32 SCCs in the 12 months post-interruption. This significantly outnumbers reports in the literature in an immunocompetent individual.

Conclusion:

This case report highlights a potential unclear mechanism of rapid SCC development associated with apremilast.

  1. Woo YR, Park CJ, Kang H, Kim JE. The Risk of Systemic Diseases in Those with Psoriasis and Psoriatic Arthritis: From Mechanisms to Clinic. Int J Mol Sci 2020;21(19).
  2. Kahn JS, Casseres RG, Her MJ, Dumont N, Gottlieb AB, Rosmarin D. Treatment of Psoriasis With Biologics and Apremilast in Patients With a History of Malignancy: A Retrospective Chart Review. J Drugs Dermatol 2019;18(4).
  3. van Lümig PP, Menting SP, van den Reek JM, Spuls PI, van Riel PL, van de Kerkhof PC, et al. An increased risk of non-melanoma skin cancer during TNF-inhibitor treatment in psoriasis patients compared to rheumatoid arthritis patients probably relates to disease-related factors. J Eur Acad Dermatol Venereol 2015;29(4):752-60.
  4. Harwood CA, Leedham-Green M, Leigh IM, Proby CM. Low-dose retinoids in the prevention of cutaneous squamous cell carcinomas in organ transplant recipients: a 16-year retrospective study. Arch Dermatol 2005;141(4):456-64.