Skin Cancer, Medications and Medical Conditionsby Kevin Berman, M.D. Health Professional
Hi everyone. Today, I want to talk about some medical conditions and their treatments in relation to skin cancer. While most people accept that treatments and medications have side effects, nobody wants to hear that medications they must take for one condition may lead to cancer of another organ. Unfortunately, some diseases require very strong and unique treatments that carry a real risk of future cancers. I am going to focus on skin cancers and for the most part, the risk of the skin cancer is outweighed by the benefits of the treatments.
Transplant patients (usually kidney or liver transplants) are frequent visitors to the dermatologist as the immunosuppressive medications they must take put them at a higher risk of skin cancer, usually squamous cell carcinoma. After a transplant, a person is put on multiple medications to prevent his/her body and immune system from rejecting the transplanted organ. So they are put on potent medications that make them more susceptible to infections and also skin cancers.
The body normally uses its immune system to ward off infections and is in constant surveillance for cancers, so suppressing this system will potentially lead to more cancers.
Of course, these patients cannot live without successful transplants so getting skin cancers may be a small price to pay for a life saving transplant.
While transplants may seem like a unique situation, the medication alluded to above are often used for patients with other conditions on a chronic basis. The most common type of conditions treated with immunosuppressive medications is the autoimmune conditions, in which a person's immune system is suppressed to prevent the body from attacking itself. Lupus, rheumatoid arthritis, and scleroderma are three such conditions which are difficult to treat and whose treatments often overlap with those of the transplant patients.
In these cases where the condition is comes under control but is not cured, people are on various medications for years to decades. In addition to skin cancers, the rate of leukemias and lymphomas also are increased.
Psoriasis and eczema are very common skin conditions affecting millions of people across the world. Dermatologists often treat these conditions with artificial sunlight, similar to a tanning bed. We use this tool as the sunlight will suppress the immune system in the skin, which is overactive in these conditions. So while we are helping their skin in the short term, this treatment may lead to increased skin cancers in the future as we know that sunlight leads to skin cancer. While it seems ironic that dermatologists, who warn of sun damage, use sunlight to treat these conditions but we do so with caution to make sure we use a specific wavelength of light to help with the skin disease while minimizing the potential for cancer. However, the potential for skin cancer is real and the benefits and risks must be evaluated. We also use the immunosuppressive medications used for lupus and transplant patients and these also carry the risk of future skin cancers. Newer medicines used for these conditions suppress specific parts of the immune system in a more targeted manner so they are in many ways safer (Enbrel and Humira and Remicade are the medications).
However, these also have risks and within the past year, there was a report of two patients with a recurrence/progression of melanoma after taking these medications. While the link is not completely defined, a history of skin cancer or other cancers is a cause for caution when contemplating the immunosuppressive medications.
I hope this blog gives you some information about treatments and medications that can predispose to skin cancer. The risks and benefits of any medicine or treatment should be discussed with your physician.