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.

Keywords: biologics; melanoma; non-melanoma skin cancer; psoriasis; skin cancer.

Figure 1

PRISMA flow-chart showing the process of literature search and study selection.

Figure 2

Risk of bias assessment through the Newcastle-Ottawa Scale presented as percentages across all included cohort studies (A) and case–control studies (B).

Figure 3

Forest plot of the estimated skin cancer incidence per 10,000 person-years along with 95% confidence intervals, stratified by skin cancer type. RE, Random-Effects model; FE, Fixed Effect model.