Patients with a history of autoimmune disease and nonmelanoma skin cancer (NMSC) may be at an increased risk for a second nonmelanoma skin cancer with the use of methotrexate, especially those patients being treated for rheumatoid arthritis and are undergoing antitumor necrosis factor (TNF) therapy, according to a recent study published online ahead of print in JAMA Oncology.

Researchers led by Frank Sctott, MD, MSCE, of the University of Pennsylvania in Philadelphia conducted a retrospective cohort study of 9 460 patients with rheumatoid arthritis or inflammatory bowel disease who were being treated with methotrexate, anti-TNF therapy, or thiopurines to determine risk of second NMSC.

They found that the incidence rate of a second NMSC per 1000 person-years was 58.2 for patients with rheumatoid arthritis and 58.9 in those with inflammatory bowel disease.

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In patients with rheumatoid arthritis, methotrexate use with other medications was associated with an increased risk of a second NMSC. Upon adjusting for other medications, risk of NMSC was found to increase with 1 year or more of methotrexate use.

Additionally, the researchers found that compared with methotrexate alone, addition of anti-TNF drugs was not significantly associated with risk of NMSC.

“Further long-term studies are required before one can conclude that thiopurine and/or anti-TNF do not increase the risk of a second NMSC in patients with inflammatory bowel disease,” the authors concluded.


1. Scott FI, Mamtani R, Brensinger CM, et al. Risk of nonmelanoma skin cancer associated with the use of immunosuppressant and biologic agents in patients with a history of autoimmune disease and nonmelanoma skin cancer [published online ahead of print October 28, 2015]. JAMA Oncol. doi:10.1001/jamadermatol.2015.3029.