title: Melanoma and Non-Melanoma Skin Cancer Associated with Angiotensin-Converting-Enzyme Inhibitors, Angiotensin-Receptor Blockers and Thiazides: A Matched Cohort Study.
abstract: Controversy exists about an association between angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), and thiazides (TZs) and the risk of malignant melanoma (MM), and non-melanoma skin cancer-basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
  
  
  
  The aim of this study was to determine if an association exists for ACEI, ARB, or TZ exposure and skin cancers.
  
  
  
  This was a matched cohort study using a large electronic medical records repository, the Northwestern Medicine Enterprise Data Warehouse (NMEDW). The exposed population consisted of patients with a documented order for an ACEI, ARB, or TZ with no prior history of skin cancer. The control population consisted of matched patients without documented exposure to ACEI, ARB, or TZ and no previous skin cancer. Incident MM, BCC, or SCC diagnosis by ICD-9 codes was recorded. Odds ratios (ORs) were obtained by using logistic regression analyses.
  
  
  
  Among the 27,134 patients exposed to an ACEI, 87 MM, 533 BCC, and 182 SCC were detected. Among the 13,818 patients exposed to an ARB, 96 MM, 283 BCC, and 106 SCC were detected. Among the 15,166 patients exposed to a TZ, 99 MM, 262 BCC, and 130 SCC were detected. Significant associations using ORs from logistic regression were found for MM and TZs (OR 1.82; 95% confidence interval [CI] 1.01-3.82); BCC and ARBs (OR 2.86; 95% CI 2.13-3.83), ACEIs (OR 2.23; 95% CI 1.78-2.81) and TZs (OR 2.11; 95% CI 1.60-2.79); SCC and ARBs (OR 2.22; 95% CI 1.37-3.61), ACEIs (OR 1.94; 95% CI 1.37-2.76), and TZs (OR 4.11; 95% CI 2.66-6.35).
  
  
  
  A safety signal for ACEIs, ARBs, and TZs and BCC and SCC, as well as for TZs and MM, was detected. An increased awareness and education, especially for those who are at high risk for skin cancer, are warranted for patients and healthcare providers. Further exploration of such associations for these commonly used drug classes is warranted.
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Nardone
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Majewski
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Kim
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Kiguradze
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
authors.forename: Estela M
authors.initials: EM
authors.lastname: Martinez-Escala
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
authors.forename: Rivka
authors.initials: R
authors.lastname: Friedland
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Amin
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Laumann
authors.affiliation: Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Beatrice J
authors.initials: BJ
authors.lastname: Edwards
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Rademaker
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Martini
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA. dwest@northwestern.edu.|Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. dwest@northwestern.edu.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: West
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D049971:Thiazides / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D049971:Thiazides