Non-Melanoma Skin Cancers Coverage from Every Angle

Are Patients Treated With TNF-Alpha Antagonists for Inflammatory Bowel Disease at Risk for Skin Cancer?

By: Sarah Campen, PharmD
Posted: Monday, February 8, 2021

The use of tumor necrosis factor-alpha (TNF-α) antagonists in patients with inflammatory bowel disease may be associated with a more severe non-melanoma skin cancer phenotype, according to a case series published in Digestive Diseases and Sciences. “Patients with inflammatory bowel disease on TNF antagonist therapy are potentially at risk of a high-risk non-melanoma skin cancer presentation,” stated Aze Suzanne Wilson, MD, PhD, of Western University, London, Ontario, and colleagues. “This further emphasizes the need for close monitoring for consequences of widespread immunosuppression.”

This retrospective case series included 472 patients with inflammatory bowel disease who were seen at London Health Sciences Center in London, Ontario. A total of 11 patients were diagnosed with non-melanoma skin cancer; 7 were on a TNF antagonist at the time of diagnosis. All seven patients with TNF antagonist exposure presented with a high-risk lesion, based on the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines®).

The average lesion size at diagnosis was 55 mm, and three patients—two with basal cell carcinoma and one with cutaneous squamous cell carcinoma—had positive margins following initial resection of the lesion. One patient required radiotherapy.

No patients in this case series presented with metastatic disease or had a recurrent non-melanoma skin cancer. TNF antagonist therapy was discontinued in one patient who presented with basal cell carcinoma, and an alternate treatment was initiated. “Larger studies are needed to confirm whether TNF antagonist discontinuation should be considered in the setting of non-melanoma skin cancer diagnosis in inflammatory bowel disease,” concluded the authors.

Disclosure: For full disclosures of the study authors, visit

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