Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Unusual skin cancer linked to chronic allergy from metal orthopedic implant

10.10.2014

In rare cases, patients with allergies to metals develop persistent skin rashes after metal devices are implanted near the skin. New research suggests these patients may be at increased risk of an unusual and aggressive form of skin cancer.

Metal alloys help make orthopedic implants stronger and more durable. But people with sensitivity to these metals, which  include nickel, cobalt and chromium, can develop chronic inflammation that promotes the development of skin cancers, report researchers at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis.


S. Demehri and T. Cunningham

Activated immune cells, shown in red and green, cluster at the site of an allergic skin rash. Scientists have learned that this inflammation can promote skin tumor formation if it persists.

The team’s findings were published online Oct. 8 in the Journal of Clinical Investigation.

The researchers were alerted to the connection by a patient who had surgery at another hospital to have a metal rod implanted to repair a fractured ankle. After the surgery, the patient developed a skin rash on her ankle, near the location of the implant.

The patient turned out to be allergic to nickel in the implant, which led surgeons at the other hospital to remove it. But the rash persisted, and a few years later, a rare form of skin cancer known as Marjolin’s ulcer developed at the surgical site. The cancer, which had become painful and ulcerated, was diagnosed and removed by physicians at Barnes-Jewish Hospital.

The researchers showed in mouse models that chronic skin inflammation caused by continuous skin contact with allergens contributes to tumor development. The finding suggests that patients with metal implants near the skin may need to be monitored for this type of inflammation, according to the researchers. The results likely also will lead to debate and further research on whether physicians should test for metal sensitivity in patients preparing for surgery to get these types of implants.

Chronic inflammation from metal implants can cause joint pain and swelling and contribute to joint failure. And when these implants are placed near the skin, fewer than 5 percent of patients develop an inflammatory rash related to the implant.

The patient’s diagnosis with Marjolin’s ulcer, an invasive and potentially deadly squamous cell cancer, surprised physicians. The patient was under 50 years old, and Marjolin’s ulcer is extremely rare in people who are young and otherwise healthy. This type of cancer most often is identified in patients with a previous history of skin cancers, but this patient had never had skin cancer.

To investigate whether inflammation from the implant contributed to the tumor, the researchers studied mouse models of contact allergy.

“A contact allergy is a different kind of reaction from allergies to pollen, pet dander or food,” said senior author Wayne M. Yokoyama, MD, a Howard Hughes Medical Institute investigator at the School of Medicine. “A contact allergy usually develops when an allergen touches the skin or is close to it. Skin rash in response to nickel and poison ivy are two common examples of contact allergies.”

The researchers showed that contact allergy brings inflammatory cells and molecules to the site of the allergic reaction. If the contact allergen remains a long time – as was the case with the patient’s implant – different inflammatory cells and molecules become active at the site of the reaction. The new mix of cells and molecules promotes the development of skin tumors.

“This model supported cancer development so strongly that some mice developed invasive squamous cell skin cancers similar to the patient’s tumor,” said lead author Shadmehr Demehri, MD, PhD, a dermatologist and postdoctoral fellow.

When the researchers examined the cells and molecules involved in chronic contact allergy in mice, they identified several that already had been linked to tumor development. Some of these cells and molecules also were present in biopsy samples from the patient’s ankle. The scientists are working to identify which inflammatory cells and molecules are most supportive of cancer formation.

“If you’re allergic to something, the first thing to do is to avoid it, but the patient couldn’t,” said Yokoyama, the Sam and Audrey Loew Levin Professor of Medicine. “Some nickel had likely seeped from it into her tissue and was still present in her skin even after the implant was removed. It’s as if a patient allergic to poison ivy kept putting poison ivy on the skin.”

To prevent such adverse events, the researchers suggested that the potential for allergic reactions to metal implants be assessed  in patients who have had the implants and in patients preparing to receive them.

“Allergen-free versions of some implants are available,” Demehri said. “These versions may cost more or be less durable, but for some patients with sensitivity to metals, they may be the best option.”

Similar to metal implants, some dental restoration materials and tattoo inks contain substances associated with allergic reactions and cancers on the skin or in the mouth. Those clinical observations also could  be explained by the new findings. The researchers suggested that the potential for these other allergens to promote skin cancer needs to be examined further. 

This research and the investigators who conducted it were supported by the National Institutes of Health (NIH) (S10-RR0227552), the Howard Hughes Medical Institute, the American Skin Association and the Dermatology Foundation.

Demehri S, Cunningham TJ, Hurst EA, Schaffer A, Sheinbein DM, Yokoyama WM. Chronic allergic contact dermatitis promotes skin cancer. The Journal of Clinical Investigations, online Oct. 8, 2014.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Michael C. Purdy | Eurek Alert!
Further information:
http://news.wustl.edu/news/Pages/27504.aspx

More articles from Health and Medicine:

nachricht Enabling technology in cell-based therapies: Scale-up, scale-out or program in-place
23.07.2018 | SLAS (Society for Laboratory Automation and Screening)

nachricht FAU researchers identify Parkinson's disease as a possible autoimmune disease
23.07.2018 | Friedrich-Alexander-Universität Erlangen-Nürnberg

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Future electronic components to be printed like newspapers

A new manufacturing technique uses a process similar to newspaper printing to form smoother and more flexible metals for making ultrafast electronic devices.

The low-cost process, developed by Purdue University researchers, combines tools already used in industry for manufacturing metals on a large scale, but uses...

Im Focus: First evidence on the source of extragalactic particles

For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.

To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...

Im Focus: Magnetic vortices: Two independent magnetic skyrmion phases discovered in a single material

For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.

Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...

Im Focus: Breaking the bond: To take part or not?

Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.

A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...

Im Focus: New 2D Spectroscopy Methods

Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.

"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Leading experts in Diabetes, Metabolism and Biomedical Engineering discuss Precision Medicine

13.07.2018 | Event News

Conference on Laser Polishing – LaP: Fine Tuning for Surfaces

12.07.2018 | Event News

11th European Wood-based Panel Symposium 2018: Meeting point for the wood-based materials industry

03.07.2018 | Event News

 
Latest News

Enabling technology in cell-based therapies: Scale-up, scale-out or program in-place

23.07.2018 | Health and Medicine

Abrupt cloud clearing events over southeast Atlantic Ocean are new piece in climate puzzle

23.07.2018 | Earth Sciences

The Maturation Pattern of the Hippocampus Drives Human Memory Deve

23.07.2018 | Science Education

VideoLinks
Science & Research
Overview of more VideoLinks >>>