Implant-Related Chronic Allergic Dermatitis May Promote Skin Cancer

By Anne Harding

October 17, 2014

NEW YORK (Reuters Health) - Allergic contact dermatitis (ACD) associated with implantable medical devices can promote skin cancer development, according to a new case report and experimental findings published October 8 online in The Journal of Clinical Investigation.

Specialists who implant potentially allergenic materials, as well as dermatologists, should be aware that this can occur, Dr. Shadmehr Demehri of Washington University School of Medicine in St. Louis, the study's first author, told Reuters Health in a telephone interview.

Also, he added, patients who require implants should undergo patch testing beforehand to determine if they are allergic to any of the materials.

In the new report, Dr. Demehri and his colleagues describe a 46-year-old woman who developed a non-healing skin lesion on her ankle, near where a metal rod had been placed to stabilize a fracture. The patient was found to be allergic to nickel, and the rod was removed a year after the surgery, but the lesion did not heal.

Three years after the surgery, the patient had erythema, pain, and oozing at the site of the lesion, as well as evidence of chronic sun exposure on nearby skin. She was found to have an invasive squamous cell carcinoma (SCC), or Marjolin's ulcer. Surgeons removed the tumor with clean margins, and it did not return during two years of follow-up.

To investigate whether ACD could promote the development of cancer in carcinogen-exposed skin, Dr. Demehri and his colleagues conducted a series of studies in mice. They treated all animals with DMBA, a laboratory carcinogen, to mimic the patient's sunlight exposure, and then sensitized them to 1-fluoro-2,4-dinitrobenzene (DNFB). The researchers then applied DNFB or acetone several times to the skin that had been treated with DMBA.

The DNFB-treated animals developed papillomas and aggressive SCC, while those treated with acetone did not. In mice that could not mount an inflammatory response, skin cancers were less likely to develop with DNFB treatment than in mice with an intact inflammatory response.

The investigators also examined the skin surrounding the patient's lesion, which showed inflammation similar to that seen in the mice.

While there have been reports of patients with tattoos developing ASD and then, eventually, skin cancer, as well as skin cancer after ASD related to dental implants, the new report is the first to describe the phenomenon in a patient with a device implanted under the skin, Dr. Demehri said. The patient had a "perfect storm" of chronic sun exposure and nickel allergy that led to the development of her skin cancer, he added.

"It suggests that this type of adverse event could be perhaps prevented with better monitoring of these patients when they're getting these implants," Dr. Demehri said, noting that patch testing is especially important.


J Clin Invest 2014.


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