Incidence of Skin Cancer in Patients With Chronic Inflammatory Cutaneous Diseases on Targeted Therapies: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Cancer is one of the several comorbidities that have been linked with chronic cutaneous inflammatory diseases namely psoriasis/psoriatic arthritis and hidradenitis suppurativa. Although the chronic inflammatory state, typical of the diseases, may induce pro-tumorigenic effects, the debate whether or not the drugs currently used in clinical practice do in facts increase a patient’s risk of malignancy remains largely unsolved. The therapeutic armamentarium has been greatly enhanced at least in the last two decades with the advent of biologics, a heterogeneous group of laboratory-engineered agents with more in the pipeline, and other targeted small molecules. Among the organ systems, skin results as one of the most commonly affected, non-melanoma skin cancers being the main drug-induced manifestations as side effect in course of these treatments. The objective of the study is to systematically review the cutaneous malignancy risk of the newer therapies through an overview of meta-analyses and observational studies on the topic.

Psoriasis Therapy and Skin Cancer: A Review

“…In accordance with these findings, a recent systematic review and meta-analysis suggests no differences exist for induction of melanoma between treatment of chronic cutaneous diseases with TNFi or ustekinumab and treatment with conventional systemic immunosuppressive drugs, while data on NMSC are more controversial. These results are in agreement with those obtained from the German Psoriasis Registry PsoBest, performed in 2008, with a follow-up period of 10 years; in this cohort, no relevant differences were found among any of these drugs with respect to melanoma skin cancer and non-melanoma skin cancer [ 47 , 48 ].…”

Neoplastic Implications in Patients Suffering from Hidradenitis Suppurativa under Systemic Treatments

“…The possible role that the TNF-alpha inhibitor played in the development of SCC on HS lesions, and concomitant sepsis, was unclear, because there was just a significant baseline immune dysregulation in their patient and an increased infectious risk were clearly reported with this drug class [ 6 ]. How and to what extent TNF-alpha inhibitors may promote the development of NMSC still remains controversial [ 10 ]. Sure enough, a meta-analysis of 74 randomized controlled trials failed to confirm or refute that anti-TNF-alpha agents caused an increase in the development of malignancy [ 84 ].…”

“…There is also an association with autoimmune comorbidities with a significant overlap between patients with HS and inflammatory bowel disease (IBD), especially Crohn’s disease (CD) [ 6 , 8 ]. Several case reports of co-occurrence of HS and nonmelanoma skin cancer suggested a causal relationship, but firm epidemiological data are lacking [ 9 , 10 ]. In an attempt to assess the link between HS and cancer, we performed a systematic review of the current literature on the topic.…”

Evaluation of risk in chronic cutaneous inflammatory conditions for malignant transformation

“…89 In the past two decades, increasing evidence of the association between NMSC and HS has emerged. [90][91][92][93][94] The prevalence of NMSC amongst these patients is estimated to be between 0.5% to 4.6%. 95,96 A study of over 2000 Swedish patients with HS showed that these patients have a 4.6-fold increased risk for developing NMSC.…”