Immunosuppressed patients may accrue skin cancer at higher rates than healthy patients
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Key takeaways:
- Immunosuppressed patients had more cutaneous squamous cell carcinomas per year vs. controls (0.44 vs. 0.82).
- Patients exposed to systemic medication classes for more than 6 months had higher accrual rates.
Patients with certain autoimmune and inflammatory conditions may develop cutaneous squamous cell carcinoma at higher rates than immunocompetent patients, according to a study.
“Data is limited on the risk of skin cancers in different non-organ transplant immunosuppressed patients,” Emily S. Ruiz, MD, MPH, associate professor of dermatology at Harvard Medical School, director of the high-risk skin cancer clinic at Dana-Farber Cancer Institute, and program director of the micrographic surgery and dermatologic oncology fellowship and academic director of the micrographic surgery center at Brigham and Women’s Hospital, told Healio. “Tumor accrual in inflammatory conditions has not been well defined and is an important metric to consider for patients who are at greater risk for developing skin cancers.”
Ruiz and colleagues conducted a retrospective review assessing the impact that disease type, duration of immunosuppression, and systemic medications have on cutaneous squamous cell carcinoma (CSCC) accrual rates, which is the number of CSCC tumors a patient develops per year.
Data on 94 immunosuppressed patients were used in the study including 31 patients with rheumatoid arthritis, 17 with inflammatory bowel disease, 11 with psoriasis, 24 with other autoimmune diseases and 21 with other inflammatory diseases.
Results showed that, compared with the 188 immunocompetent controls, immunosuppressed patients overall experienced significantly higher CSCC accrual rates (0.44 vs. 0.82; P < .01).
As far as individual diseases, those with psoriasis saw the highest accrual rates (1.06) followed by those with irritable bowel disease (0.94) and rheumatoid arthritis (0.88; P < .01 for all). Those with autoimmune and inflammatory diseases both saw accrual rates of 0.72 (P < .01 for both).
The researchers also found an association between increased tumor accrual rates and exposure to any systemic medication classes with patients exposed for more than 6 months experiencing a higher accrual rate than controls.
This included immunomodulators (0.95), TNF-inhibitors (0.89), non-TNF inhibitor biologics (0.78) and corticosteroids (0.93; P < .001 for all). On the other hand, there was no association between accrual rates and the number of systemic medication class exposures or duration of immunosuppression.
“We found that patients with rheumatoid arthritis, irritable bowel disease, psoriatic arthritis and other autoimmune and inflammatory conditions developed tumors at a higher rate than non-immunosuppressed controls,” Ruiz told Healio. “This study highlights the importance of skin cancer surveillance in these patients.”