Study Links Atopic Dermatitis to 36% Increase in Risk of Nonmelanoma Skin Cancers

Mark Lebwohl, MD
Credit: Vitiligo Research Foundation

Risk of nonmelanoma skin cancer was greater among patients with atopic dermatitis than among their counterparts without the dermatologic condition, according to a new study.

Presented at the Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting, results of the study, which matched patients with atopic dermatitis to non-atopic dermatitis controls and patients with rheumatoid arthritis (RA), results indicate the risk of non melanoma skin cancers among patients with atopic dermatitis was 36% greater than their counterparts without the disease and comparable to the risk among those with RA.¹

“Patients with [atopic dermatitis] demonstrated a higher [non-melanoma skin cancer] risk compared with non-[atopic dermatitis] matched controls, and a similar [nonmelanoma skin cancer] risk compared with patients with RA; patterns were consistent for patients with moderate-to-severe disease. [Nonmelanoma skin cancer] risk was higher in patients with [atopic dermatitis] with a history of [nonmelanoma skin cancer] or other malignancies,” wrote investigators.

As is true with many dermatologic conditions, diagnosis of atopic dermatitis is associated with an increased risk of skin cancers. However, according to investigators of the current study, the association between atopic dermatitis and risk of non melanoma skin cancers is less clear. With this in mind, investigators, who were led by Mark Lebwohl, MD, of the Icahn School of Medicine at Mount Sinai, designed their study as a retrospective analysis of claims data from the Optum Clinformatics Data Mart.^1,2

Investigators limited their study to adult patients aged 18 years or older diagnosed with atopic dermatitis between March 2017 and March 2023. For the purpose of analysis, a diagnosis of atopic dermatitis was considered as 2 or more claims for atopic dermatitis or 1 or more claims for atopic dermatitis or eczema with asthma and/or hay fever, food allergies, or allergic rhinitis. Investigators classified patients as having moderate-to-severe atopic dermatitis if they received dupilumab for atopic dermatitis or advanced systemic therapy for RA during follow-up.¹

For the purpose of analysis, patients meeting the aforementioned criterion were matched in a 1:1 ratio to non-atopic dermatitis controls by age, sex, and cohort entry date. Investigators also created control cohort of patients with rheumatoid arthritis based on similar criteria.¹

The primary outcomes of interest for the analysis ere the crude incidence rates of nonmelanoma skin cancer among these cohorts as well as the relative risk (RR). Investigators pointed out RR was estimated using multivariable Cox proportional hazard models adjusted for baseline demographics, comorbidities, and medications.¹

In total, investigators identified 391,753 patients with atopic dermatitis, including 7136 with moderate-to-severe atopic dermatitis, for inclusion in the study. Investigators also identified 97,445 patients with RA, including 35,486 with moderate-to-severe RA, from the same period. After matching, the matched atopic dermatitis and non-atopic dermatitis cohorts included 381,221 patients each while the matched moderate-to-severe atopic dermatitis and non-atopic dermatitis control cohort included 7134 patients each.¹

Crude incidence rates for nonmelanoma skin cancer incidence per 100 patient-years were:¹

• 2.12 (95% CI, 2.10 to 2.15) for atopic dermatitis and 1.74 (95% CI, 1.72 to 1.77) for matched controls
• 2.11 (95% CI, 1.87 to 2.35) for moderate-to-severe atopic dermatitis and 1.28 (95% CI, 1.10 to 1.47) for matched controls
• 2.33 (95% CI, 2.28 to 2.38) for RA
• 2.03 (95% CI, 1.94 to 2.12) for moderate-to-severe RA.

In adjusted analyses, results indicated risk was greater among those with atopic dermatitis than the matched controls (adjusted Hazard Ratio [aHR], 1.32; 95% CI, 1.30 to 1.35; P < .001) as well as among those moderate-to-severe atopic dermatitis relative to matched controls (aHR, 1.36; 95% CI, 1.12 to 1.65; P < .01). Further analysis suggested there was no significant difference in nonmelanoma skin cancer risk among those with atopic dermatitis relative to those with RA (aHR, 1.03; 95% CI, 1.00 to 1.06) or moderate-to-severe atopic dermatitis compared with moderate-to-severe RA (aHR, 0.97; 95% CI, 0.87 to 1.08).¹

Investigators highlighted results of additional analyses revealing relative risk reductions of 35% or greater among patients with atopic dermatitis who were female, or Asian and Hispanic.¹

“Characterizing the underlying [nonmelanoma skin cancer] risk among patients with [atopic dermatitis] may inform treatment benefit-risk assessments,” investigators added.¹

References:

1. ^{Lebwohl M, Emma Yue E, Whitney Krueger W, Berman BBunick CG, SchlesingerT, Grada A. Risk of non-melanoma skin cancer in patients with moderate-to-severe atopic dermatitis: a United States population-based study using claims data. Abstract presented at Revolutionizing Atopic Dermatitis 2024. Chicago, Il. June 08-10, 2024.}
2. ^{Zhu Y, Wang H, He J, et al. Atopic Dermatitis and Skin Cancer Risk: A Systematic Review. Dermatol Ther (Heidelb). 2022;12(5):1167-1179. doi:10.1007/s13555-022-00720-2}