Methotrexate may increase skin cancer risk in patients with psoriasis
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Key takeaways:
- Patients with psoriasis taking methotrexate were 2.8 times more likely to develop nonmelanoma skin cancer than those not taking the drug.
- Patients taking methotrexate should get regular body scans during treatment.
Psoriasis patients taking methotrexate were nearly three times as likely to develop nonmelanoma skin cancer compared with those not taking the drug, according to a study.
“Although the use of methotrexate has been associated with nonmelanoma skin cancer development, the extent of the nonmelanoma skin cancer risk associated with methotrexate therapy in patients with psoriasis is not well quantified,” Margaret E. Lang Houser, MD, of the dermatology department at University of Michigan, and colleagues wrote. “Given the high frequency with which methotrexate is used in patients with psoriasis, this lack of conclusive data about the actual risk represents a gap in our knowledge and affects a large population of patients who could potentially benefit from more comprehensive counseling.”
In a systematic review, researchers assessed the relationship between methotrexate and the development of nonmelanoma skin cancer in patients with psoriasis.
After screening for nine cohort and case-control comparative studies, researchers identified 2,192 patients with psoriasis who were taking methotrexate and 9,683 who were not.
Results showed that 7.8% of patients with psoriasis treated with methotrexate developed nonmelanoma skin cancer compared with only 1.2% of the other patients with psoriasis. This means that patients taking methotrexate are 2.8 times more likely to develop nonmelanoma skin cancer compared with patients not taking the drug (95% CI, 1.47-5.39).
Additional analysis revealed that cohort studies alone also showed a higher risk for nonmelanoma skin cancer was associated with patients taking methotrexate compared with those not taking the drug; however, this finding was not statistically significant (OR = 2; 95% CI, 0.91-4.35).
Case-control studies alone also found significantly higher risks for nonmelanoma skin cancer associated with methotrexate usage (OR = 4.54; 95% CI, 1.52-13.54).
“The findings of this meta-analysis highlight the need to provide thorough patient education on the risks of skin cancer development, especially in patients treated with methotrexate,” the authors concluded.
Perspective
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Although the study is interesting, it only shows an association and not causation between methotrexate and skin cancer and there is not enough evidence to change clinical treatment guidelines at this time. However, the discussion above is important when considering treatment with methotrexate.
For patients who are currently taking methotrexate, they should be getting regular full body skin exams while on treatment for early diagnosis and treatment of skin cancers. Questions should also be asked about other risk factors for skin cancer and if they are high risk. If so, then this should be part of the risk/benefit discussion when considering methotrexate as a treatment option. Patients on methotrexate should also be getting regular skin checks for skin cancer surveillance.
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