Tina Bhutani, MD: Skin Cancer Associated with Methotrexate for Psoriasis Patients

Tina Bhutani, MD, MAS, spoke with HCPLive in an interview about a recent study that found an association with methotrexate use and development of non-melanoma skin cancer in psoriasis patients.

Bhutani is known for her work both as a dermatologist and as co-director of the Dermatology Clinical Research Unit at University of California San Francisco Health. She is also an advisor to Zerigo Health.

Her research has focused on treating chronic inflammatory skin diseases, such as psoriasis and eczema. At the UCSF Psoriasis and Skin Treatment Center, Bhutani specializes in helping complex cases in need of treatment with multiple modalities.

“So methotrexate is an age-old treatment we've used for many, many years for psoriasis,” she explained. “And although we talk about many immunomodulating agents, especially our older systemic therapies, having a possible increased risk of skin cancer, particularly non-melanoma skin cancer, I don't think it's something that's quite often highlighted, especially for drugs like methotrexate.”

Bhutani noted that this is the reason for her interest, given that the research added new knowledge to dermatologists’ clinical acumen.

“I think when we use methotrexate, the main thing that we usually are talking about with patients is really liver toxicity,” she explained. “Especially when we're using methotrexate for many, many years, longitudinally, we kind of calculate how much lifetime dosing someone has had of methotrexate.”

Additionally, Bhutani noted that skin cancer risk was not something that clinicians always discuss with regard to a relationship with methotrexate.

“Although theoretically, it would make sense that a medication which suppresses certain parts of the immune system would potentially lead to skin cancer risk,” she stated. “And so this study highlights that there might be a potential increase in skin cancer risk. In fact, quite a high increased risk of skin cancer with methotrexate. They quote, I think, an odds ratio of 2.8 in this meta analysis.”

Bhutani added this potential danger should become a consideration for dermatologists when considering the treatment. She later noted, however, that certain variables were not controlled for such as patient ages or prior use of PUVA therapy.

“Although it highlights an important concern, I don't think it definitely confirms the fact that methotrexate can increase the risk of non melanoma skin cancer,” she said. “You know, this wasn't a meta-regression, it was a meta-analysis…So I think those are all important factors that would need to be studied a little bit more.”

To find out more about this research into methotrexate, watch the full HCPLive interview segment above.