Multiple squamous cell carcinomas in the setting of psoriasis treated with etanercept: a report of four cases and review of the literature.

BACKGROUND Psoriasis is a common, chronic, hyperproliferative disease of the skin characterized by overexpression of type 1 cytokines, including tumor necrosis factor α. There is concern that antitumor necrosis factor agents such as etanercept may increase the incidence of cutaneous malignancies; however, the data are conflicting. Our objective was to further understand the characteristics and association of squamous cell carcinoma (SCC) development in patients with psoriasis who used etanercept. METHODS Four patients with psoriasis were identified as having SCCs in the setting of etanercept. The histories of these patients were reviewed retrospectively. RESULTS All four patients had lifelong psoriasis. The mean time of SCC onset was 11 months after etanercept therapy was begun (range, 1-17 months), and the number of SCCs in each patient ranged from five to more than 50. CONCLUSIONS Currently, reports are conflicting about the effect of etanercept on SCC development. We present the first case series of patients in whom SCC developed in the setting of etanercept therapy. More research is needed to better characterize the effects of etanercept on the development and behavior of SCC in patients with psoriasis.