Risk of Developing Melanoma With Systemic Agents Used to Treat Psoriasis: A Review of the Literature

Abstract

Background Psoriasis is a chronic inflammatory skin disease induced by autoimmune-like dysregulation of the immune system. Treatment options have drastically evolved in recent years, and treatment advances that target specific cytokines and other molecules involved in dysregulation have had a profound effect in controlling the disease. Objective We reviewed the literature to assess the risk of developing melanoma with conventional therapies and newer agents used to treat psoriasis. Methods A comprehensive literature search using Medline (via Ovid) and Embase was conducted. Results The majority of studies reviewed reported insignificant results. Potential risk for melanoma was identified for only 3 out of 15 anti-psoriatic treatments analyzed: adalimumab (relative risk 1.8, 95% CI 1.06-3.00), etanercept (relative risk 2.35, 95% CI 1.46-3.77) and infliximab (Empirical Bayes Geometric Mean 7.90, 95% CI 7.13-8.60). The confidence intervals provided are from prior studies. There are not enough collective data on newer agents to make any conclusions on risk. Conclusions We were unable to identify any substantial risk for developing melanoma due to the use of anti-psoriatic treatments. Until additional long-term registry data become available, it would be prudent to continue screening patients with psoriasis at baseline and periodically for melanoma when these agents are used.

Review: The Key Factors to Melanomagenesis

“…In the literature, it is noted that psoriasis patients have a higher risk of developing certain cancers, due to the inflammation that these patients have [ 47 ]. Regarding psoriasis’ therapy it seems that the biological treatments do not necessarily raise the risk for melanoma development and are considered safe [ 48 , 49 ]. One of the most common chronic inflammatory skin diseases is atopic dermatitis (AD) and there is a lot of controversy regarding the extent of skin cancer risk that these patients have [ 50 ].…”

“…Therapies/medicines—immunomodulating medicines may increase cutaneous photosensitivity and suppress the immune system’s responses, determining a higher melanoma risk [ 69 ]. Certain papers report that immunosuppressive agents like methotrexate (MTX)may increase skin cancer risk in patients with psoriasis [ 48 ]. As for melanoma suppression, it appears that resveratrol (a natural polyphenolic phytoalexin) has been demonstrated to inhibit melanoma cell viability, migration, and invasion, blocking melanoma progression [ 70 ].…”

Real-World Experience of Methotrexate in the Treatment of Skin Diseases: an Italian Delphi Consensus

“…In a recently published review on systemic drugs for psoriasis, only adalimumab, etanercept and infliximab (i.e. anti-TNFs) were found to have the potential to increase the risk of melanoma [ 29 ]. In the same review, it was noted that MTX does not increase the risk of melanoma.…”