title: Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Patients with inflammatory bowel disease (IBD) are at risk for certain malignancies. We aimed to determine the risk of melanoma and nonmelanoma skin cancer (NMSC) in patients with IBD and how medications affect these risks.
  
  
  METHODS
  We performed retrospective cohort and nested case-control studies using administrative data from the LifeLink Health Plan Claims Database from 1997 to 2009. The cohort comprised 108,579 patients with IBD, and each was matched to 4 individuals without IBD. The risk of melanoma and NMSC was evaluated by incidence rate ratio (IRR) and by adjusted Cox proportional hazard ratio (HR) modeling. In nested case-control studies, patients with melanoma or NMSC were matched to 4 patients with IBD without melanoma or NMSC. Conditional logistic regression was used to determine associations between medications and both skin cancers.
  
  
  RESULTS
  In the cohort, IBD was associated with an increased incidence of melanoma (IRR, 1.29; 95% confidence interval [CI], 1.09-1.53). Risk was greatest among individuals with Crohn's disease (IRR, 1.45; 95% CI, 1.13-1.85; adjusted HR, 1.28; 95% CI, 1.00-1.64). The incidence of NMSC also increased among patients with IBD (IRR, 1.46; 95% CI, 1.40-1.53) and was greatest among those with CD (IRR, 1.64; 95% CI, 1.54-1.74). In the nested case-control studies, therapy with biologics increased the risk of melanoma (odds ratio [OR], 1.88; 95% CI, 1.08-3.29). Patients who had been treated with thiopurines had an increased risk of NMSC (OR, 1.85; 95% CI, 1.66-2.05).
  
  
  CONCLUSIONS
  Immunosuppression increases the risk of melanoma and NMSC among patients with IBD. The risk of melanoma is increased by use of biologics, and the risk of NMSC is increased by use of thiopurines. Patients with IBD should be counseled and monitored for skin cancer.
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill, NC, USA. millie_long@med.unc.edu
authors.forename: Millie D
authors.initials: MD
authors.lastname: Long
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Martin
authors.forename: Clare A
authors.initials: CA
authors.lastname: Pipkin
authors.forename: Hans H
authors.initials: HH
authors.lastname: Herfarth
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000139:chemically induced* / Q000453:epidemiology; D015122:Mercaptopurine / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014481:United States
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D015122:Mercaptopurine