Thiopurines and non-melanoma skin cancer: partners in crime in inflammatory bowel diseases

Skin Cancer

Br Med Bull. 2020 Nov 16:ldaa033. doi: 10.1093/bmb/ldaa033. Online ahead of print.


INTRODUCTION: Several studies have shown that inflammatory bowel diseases (IBD) patients treated with thiopurines have an increased risk of developing skin cancer.

SOURCES OF DATA: This review is based on recent published literature regarding the use of thiopurines in IBD and skin malignancies.

AREAS OF AGREEMENT: Exposure to thiopurines is significantly associated with nonmelanoma skin cancer, but not with melanoma. Primary and secondary prevention including sun-protective measures and regular dermatologic screening are recommended in IBD patients, particularly in those exposed to thiopurines.

AREAS OF CONTROVERSY: Both when and how immunosuppressive therapy should be resumed in patients with a prior history of skin cancer still remain debatable topics.

GROWING POINTS: The benefit-risk balance between thiopurine therapy and risk of skin cancer should be evaluated in the drug decision process.

AREAS TIMELY FOR DEVELOPING RESEARCH: The approval of new effective strategies requires the re-evaluation of the positioning of thiopurines within the therapeutic algorithm based on an increasingly individualized approach.