Megan H. Noe
Patients with psoriasis have a small yet significant increased risk for malignancy compared with the general population, according to research presented at the American Academy of Dermatology Summer Sessions conference.
Megan H. Noe, MD, MPH, MSCE, of the department of dermatology at the University of Pennsylvania, said the increased risk is driven by higher rates of lymphoma and skin cancer among patients with psoriasis, underscoring the importance of incorporating full skin exams into psoriasis visits and encouraging patients to undergo age-appropriate cancer screening.
During a presentation, Noe reported data from more than 20 studies published between 1999 and 2018. Two studies published in 2013 and 2014 showed that patients with psoriasis had a 16% and 20% increased risk for malignancy compared with the general population. A separate analysis published in 2016 that was adjusted for age, gender, smoking status and alcohol use also demonstrated a slightly elevated risk (HR = 1.06; 95% CI, 1.02-1.09).
When comparing various cancer types, there was no association between psoriasis and prostate cancer or colorectal cancer, and studies yielded mixed results regarding the impact of psoriasis on breast cancer, lung cancer, bladder cancer and kidney cancer. However, the condition was linked to a higher risk for lymphoproliferative malignancies, particularly Hodgkin’s lymphoma, as well as melanoma and keratinocyte carcinoma.
Noe also investigated the effects of psoriasis treatment with TNF inhibitors on cancer risk.
“There was an increased risk of malignancy seen in some of the initial studies of TNF inhibitors in patients with rheumatoid arthritis; however, this increased risk of malignancies associated with TNF inhibitors has not been seen in psoriasis patients,” she told Healio Internal Medicine. “Because all psoriasis patients are at a slightly increased risk of malignancy, in many studies it can be difficult to understand if the risk of malignancy is from psoriasis or the treatment itself.”
Findings from two meta-analyses and a population-based cohort study in the United States failed to demonstrate an association between TNF inhibitors and malignancy, according to Noe. Similarly, there was no evidence of an increased risk for recurrent malignancy in patients with psoriasis and a history of malignancy who received TNF inhibitors. However, Noe warned that there are limited data examining the association, and that each patient’s risk should be considered on an individual basis and discussed with an oncologist.
“Caution should be used when considering systemic treatments in patients with active/ongoing malignancy or a recent history of cancer,” she said. “Co-management with other physicians is important to develop an individualized treatment plans for these patients.” – by Stephanie Viguers
Noe, MH. Malignancy in Patients with Psoriasis: Understanding the Risk and Appropriate Management Strategies. Presented at: The American Academy of Dermatology Summer Meeting; July 26-29, 2018; Chicago.
Disclosures: Noe reports no relevant financial disclosures.