Connective Tissue Diseases Associated With an Increased Risk of Nonmelanoma Skin Cancer

Findings from a recent study showed a greater risk of nonmelanoma skin cancer in patients with connective tissue disease (CTD) including systemic lupus erythematosus (SLE), scleroderma, and Sjogren disease.

“The incidence and odds of skin cancer in US patients with CTD has not been well studied,” wrote the researchers in Journal of Drugs in Dermatology. “It is important to determine if there is an increased incidence of skin cancer in this patient population as the first step to determine if increased screening would be warranted. CTD are associated with significant morbidity and mortality, hence any increased morbidity and mortality due to skin cancer can be minimized by early diagnosis and treatment.”

The retrospective case control cohort study from Kaiser Permanente Northern California included 8281 patients with CTD and 8281 age, race, and gender matched patients without CTD. Of the patients with CTD, 36% had SLE, 47% had Sjogren disease, and 17% had scleroderma. Patients were followed for a 5-year period between 2002-2012. The date of the first diagnosis of CTD was used as the index date for each case and matched control.
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Compared with controls without CTD, patients with CTD had an increased risk of nonmelanoma skin cancer (odds ratio [OR], 1.26; 95% CI, 1.08-1.49; P=.005) and even higher risk of squamous cell carcinoma specifically (OR, 1.47; 95% CI, 1.14-1.90; P=.003).

“The relationship between CTD and skin cancer is complicated by the use of immunosuppressive medications to treat these diseases,” said the researchers. History of immunosuppression for at least 1 year was observed in 11.4% of the CTD cohort. These patients were at higher risk for nonmelanoma skin cancer compared with those not treated with immunosuppression for CTD (OR, 1.69; 95% CI, 1.16-2.45; P=.006).

“Our study shows an increased risk of nonmelanoma skin cancer among patients with connective tissue disease. We also note that patients on immunosuppressive therapy for at least one year had an increased incidence of nonmelanoma skin cancer. Further studies are needed to confirm these findings,” concluded the researchers.

—Eileen Koutnik-Fotopoulos

Reference

Gunawardane ND, Dontsi M, Lyon LL. Risk of non-melanoma skin cancer in connective tissue disease and the impact of immunosuppressive therapy. J Drug Dermatol. 2020;19(5):519-523. doi:10.36849/JDD.2020.4781