Orthopedic Metal Allergies Linked to Cancer

Orthopedic implants placed in locations just below the skin have been known to cause contact dermatitis in those allergic to certain alloys. Now research from Washington University in St. Louis (WUSL) has shown that these allergies can lead to rare cancers.

Metals in implants have long been known to cause reactions in certain segments of the population. These allergies are often related to the presence of nickel, cobalt, or chromium that are part of the composition of orthopedic fixation devices and other implants. While it is known that these devices can cause dermatitis, the consequences of this kind of chronic inflammation are not well understood.

Recently, according to a press release from WUSL, researchers were confronted with an unusual case where a young, healthy patient developed a rare, invasive form of cancer called Marjolin’s ulcer. This cancer is often associated with older patients who already have some other form of cancer but, in this instance, the site of the ulceration was located over an area where the patient previously had an orthopedic implant. Not long after it was implanted, the patient developed contact dermatitis related to nickel, which led to the removal of the implant. Despite removal, however, the irritation persisted and, after a few years, Marjolin’s ulcer was discovered at the site.

Given the unusual circumstances, WUSL researchers decided to look deeper into how contact dermatitis might influence cancer development. Using mice and another type of allergen called 1-fluoro-2,4-dinitrobenzene (DNFB), it was shown that chronic administration of the allergen can lead to papillomas and aggressive squamous cell carcinomas.

“This model supported cancer development so strongly that some mice developed invasive squamous cell skin cancers similar to the patient’s tumor,” lead author Shadmehr Demehri, M.D., Ph.D., a dermatologist and postdoctoral fellow at WUSL, said in the press release.

With these results in hand, the team recommends that patients who may need implants get patch tested for allergies prior to implantation, according to the study.

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

Inflammation following implant placement is a risk found in tissue engineering applications as well. Efforts to reduce this inflammation and its negative effects have been made by incorporating anti-inflammatory agents into the tissue scaffold itself.