Risk of non-melanoma skin cancer in patients with psoriasis: An updated evidence from systematic review with meta-analysis

Abstract

Background Psoriasis is a chronic inflammatory skin disorder which may result in an increased cancer risk due to defects of immune surveillance. The relationship between psoriasis and risk of non-melanoma skin cancer (NMSC) has not yet been fully determined. The aim of this study was to update the evidence on the association between psoriasis and risk of NMSC. Methods We conducted an extensive literature search of publications in Pubmed, EMBASE, and Cochrane Library without restrictions on language from inception through August 2019 using predefined keywords. Eligible observational studies were selected if they assessed the risk ratio of NMSC in patients with psoriasis. Data from included studies were extracted, and meta-analysis was performed using random-effects models. Results Sixteen cohort studies involving 16,023,503 participants published between 1999 and 2019 met inclusion criteria and were included in this systematic review. Meta-analysis demonstrated that compared with patients without psoriasis, patients with psoriasis had 1.72 times higher risk of developing NMSC (RR, 1.72, 95% CI 1.46 to 2.02). Patients with moderate to severe psoriasis had higher risk of NMSC (RR, 1.82, 95% CI 1.38 to 2.41) than those had mild psoriasis (RR, 1.61, 95% CI 1.25 to 2.09) (P for interaction<0.001). Moreover, patients with psoriasis had significantly higher risk of squamous cell carcinoma (RR, 2.08, 95% CI 1.53 to 2.83) than that of basal cell carcinoma (RR, 1.28, 95% CI 0.81 to 2.00) (P for interaction<0.001). Conclusions Current evidence suggests that patients with psoriasis may have a higher risk of NMSC than psoriasis-free patients. Periodic screening for specific cancer risk is warranted in patients with psoriasis.

EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 1: treatment and monitoring recommendations

“…78 However, in this SR adjustment for highly relevant confounding factors such as prior phototherapy were lacking. 78 For more detailed information, see chapter malignancies. Other malignancies, especially lymphoma, associated with the use of certolizumab pegol, are uncommon.…”

“…Special attention is needed for non‐melanoma skin cancer (NMSC) as psoriasis patients are more at risk for NMSC 78 . However, in this SR adjustment for highly relevant confounding factors such as prior phototherapy were lacking 78 . For more detailed information, see chapter malignancies.…”

Development of squamous cell carcinoma in an untreated patient of psoriasis: a case report

“…Subsequently SCC was the second most prevalent cancer among psoriatic patients. 2,3 However it is still unclear whether the correlation of SCC with psoriasis is due to underlying genetic basis of disease or its treatments. Phototherapy, immunosuppressive therapy and other well-known therapeutic methods have made it challenging to estimate the baseline risk of SCC incidence in psoriatic patients.…”

The Risk of Systemic Diseases in Those with Psoriasis and Psoriatic Arthritis: From Mechanisms to Clinic

“…Specifically, increased risks of keratinocyte cancer (RR: 2.28; 95% CI: 1.73–3.01), lymphoma overall (RR: 1.56; 95% CI: 1.37–1.78), lung cancer (RR: 1.26; 95% CI: 1.13–1.40), and bladder cancer (RR: 1.12; 95% CI: 1.04–1.19) were observed in patients with psoriasis [ 61 ]. A recent meta-analysis by Wang et al [ 62 ] on psoriasis according to disease severity has found that the risk of NMSC in patients with moderate to severe psoriasis (RR: 1.82; 95% CI: 1.38–2.41) is higher than that in patients with mild psoriasis (RR: 1.61; 95% CI: 1.25–2.09). In those with NMSC, the risk of squamous cell carcinoma (RR: 2.08; 95% CI: 1.53–2.83) was significantly higher than the risk of basal cell carcinoma (RR: 1.28; 95% CI: 0.81–2.00) [ 62 ].…”

“…A recent meta-analysis by Wang et al [ 62 ] on psoriasis according to disease severity has found that the risk of NMSC in patients with moderate to severe psoriasis (RR: 1.82; 95% CI: 1.38–2.41) is higher than that in patients with mild psoriasis (RR: 1.61; 95% CI: 1.25–2.09). In those with NMSC, the risk of squamous cell carcinoma (RR: 2.08; 95% CI: 1.53–2.83) was significantly higher than the risk of basal cell carcinoma (RR: 1.28; 95% CI: 0.81–2.00) [ 62 ]. Collectively, these results suggest that patients with psoriasis have an increased risk of cancer, especially keratinocyte cancer and lymphoma.…”