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Level of UV Exposure, Skin Type, and Age Are More Important than Thiopurine Use for Keratinocyte Carcinoma Development in IBD Patients

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Abstract

Background

Retrospective studies observe an increased risk of keratinocyte carcinomas (KCs) in patients with inflammatory bowel disease (IBD) on thiopurine (TP) medication. The role of traditional risk factors such as skin type and sun protection behavior has not been studied in this population. This study aimed to examine traditional KC risk factors and thiopurine use on skin cancer development in an IBD cohort.

Methods

Consecutive IBD patients were recruited from four specialist centers in Australia and New Zealand, each with varying UV exposure indices. Data pertaining to race, skin color, freckling and sun protection behavior, dose of TP therapy, and skin cancer development were elicited through a self-reported questionnaire.

Results

A total of 691 IBD patients were included with 62 reporting KC development. Thiopurine usage was similar among patients who developed skin cancer compared with those who did not (92% vs. 89%, p = 0.3). There was no statistically significant association between KC development and TP dose or 6-thioguanine nucleotide levels. In multivariate modeling, four factors were independently and significantly associated with KC: age over 61 years old versus less than 30 years old (OR 6.76; 95% CI 2.38–19.18), residing in Brisbane versus Christchurch (OR 3.3; 95% CI 1.6–6.8), never staying in the shade versus staying in the shade ≥ 50% of the time (OR 3.8; 95% CI 1.4–10.5), and having a skin type that never tanned versus other skin types (OR 6.9; 95% CI 2.9–16.0).

Conclusion

Skin type, age, and sun protection behavior are more important risk factors for KC development than thiopurine medication use in this IBD population.

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Funding

This work was supported by an educational grant from Abbvie. David Whiteman has received Research Fellowship (APP1058522) from the National Health and Medical Research Council of Australia (NHMRC).

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Authors and Affiliations

  1. Department of Gastroenterology, St Vincent’s Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia

    Yang Wu & Simon Ghaly

  2. Kirby Institute, Sydney, NSW, Australia

    Stephen Kerr

  3. Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand

    Bryce Jackson & Richard B. Gearry

  4. IBD Research Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

    Katherine Hanigan, Deborah Martins, Krupa Krishnaprasad & Graham L. Radford-Smith

  5. Division of Plastic and Reconstructive Surgery, University of California San Francisco, 505 Parnassus Ave, Suite M-593, San Francisco, CA, 94143-0932, USA

    Deborah Martins

  6. Department of Gastroenterology, Flinders Medical Centre, Adelaide, SA, Australia

    Reme E. Mountifield & Peter A. Bampton

  7. Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

    David C. Whiteman

  8. Department of Gastroenterology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Graham L. Radford-Smith

  9. University of Queensland School of Medicine, Brisbane, QLD, Australia

    Graham L. Radford-Smith

  10. Centre of Inflammatory Bowel Diseases, St John of God Hospital, Subiaco, WA, Australia

    Ian C. Lawrance

  11. School of Medicine and Pharmacology, Harry Perkins Institute of Medical Research, University of Western Australia, Murdoch, WA, Australia

    Ian C. Lawrance

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  1. Yang Wu
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Correspondence to Yang Wu.

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Wu, Y., Ghaly, S., Kerr, S. et al. Level of UV Exposure, Skin Type, and Age Are More Important than Thiopurine Use for Keratinocyte Carcinoma Development in IBD Patients. Dig Dis Sci 65, 1172–1179 (2020). https://doi.org/10.1007/s10620-019-05818-w

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