Can We Miss Pigmented Lesions in Psoriasis Patients?
Condition: Psoriasis; Melanoma; Non-melanoma Skin Cancer
MeSH terms: Melanoma; Skin Neoplasms; Psoriasis
Intervention: etanercept
Intervention description: Patients will receive six months of treatment with Enbrel 50mg SQ given twice a week for the first three months and 50 mg once a week thereafter.
Intervention MeSH terms: Etanercept
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 6.0
Sex: All
Minimum age: 19 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: psoriasis; melanoma; non-melanoma skin cancer; etanercept; Enbrel

Summary:

      In psoriasis patients, thick psoriatic plaques can obscure these lesions, and clinicians rely
      heavily on visual inspection to recognize suspicious or atypical pigmented lesions. However,
      successful systemic treatment and subsequent clearing of psoriatic plaques may allow
      clinicians to better evaluate pigmented lesions, thereby increasing the likelihood of early
      identification and treatment of suspicious lesions such as nonmelanoma skin cancer and
      malignant melanoma.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Diagnosis of moderate to severe plaque psoriasis identified by a BSA greater than or
             equal to 10% and a Psoriasis Area and Severity Index score greater than or equal to 12

          2. Age 19 years or above

          3. Fitzpatrick skin type I, II or III

          4. Candidate for systemic treatment in the opinion of the investigator

          5. Willingness to undergo treatment with Enbrel as outlined above

          6. Negative pregnancy test (urine or serum β-Human Chorionic Gonadotrophin ) before the
             first dose of study drug in all women (except those surgically sterile, or at least 5
             years postmenopausal).

          7. Negative Tuberculosis skin test at entry into the study or a negative screening x-ray
             in inconclusive Purified Protein Derivative reading (borderline, reactive but
             non-diagnostic) or in prior bacille Calmette-Guerin inoculated subjects.

          8. Sexually active subjects of childbearing potential must agree to use medically
             acceptable form of contraception during screening and throughout the study

          9. Subject or designee must have the ability to self-inject study medication or have a
             care giver at home who can administer subcutaneous injections

         10. Must be able and willing to give written informed consent and comply with the
             requirements of the study protocol and must authorize release and use of protected
             health information

        Exclusion Criteria:

          1. Serum creatinine > 3.0 mg/dL (265 micromoles/L)

          2. Serum potassium < 3.5 mmol/L or > 5.5 mmol/L

          3. Serum alanine aminotransferase or Aspartate transaminase > 3 times the upper limit of
             normal for the Lab

          4. Platelet count < 100,000/mm3

          5. White blood cell count < 3,000 cells/mm3

          6. Hemoglobin, hematocrit, or red blood cell count outside 30% of the upper or lower
             limits of normal for the Lab

          7. Systemic therapy use (e.g. phototherapy, methotrexate, cyclosporine, oral steroids,
             systemic biologics) within the previous 4 weeks

          8. Topical therapy use (e.g. topical steroids, vitamin D derivatives) within the previous
             2 weeks

          9. Subject is currently enrolled in another investigational device or drug trial(s), or
             subject has received other investigational agent(s) within 28 days of baseline visit.

         10. Subjects who have known hypersensitivity to Enbrel or any of its components or who is
             known to have antibodies to etanercept

         11. Prior or concurrent cyclophosphamide therapy

         12. Concurrent sulfasalazine therapy

         13. Known Human immunodeficiency virus-positive status or known history of any other
             immunosuppressing disease

         14. Active severe infections within 4 weeks before screening visit, or between the
             screening and baseline visits

         15. Untreated Lyme disease

         16. Severe comorbidities (diabetes mellitus requiring insulin, CHF of any severity, MI,
             CVA or TIA within 3 months of screening visit, unstable angina pectoris, uncontrolled
             hypertension (sitting systolic BP <80 mm Hg or > 160 or diastolic BP > 100 mm Hg),
             oxygen-dependent severe pulmonary disease, history of cancer within 5 years [other
             than resected cutaneous basal or squamous cell carcinoma or in situ cervical cancer])

         17. History of TB or TB exposure, chronic hepatitis B or hepatitis C, SLE, history of
             multiple sclerosis, transverse myelitis, optic neuritis or epilepsy

         18. History of recent alcohol or substance abuse (< 1 year)

         19. Pregnant or lactating females

         20. Use of a live vaccine 90 days prior to, or during this study

         21. Any condition judged by the patient's physician to cause this clinical trial to be
             detrimental to the patient

         22. History of non-compliance with other therapies