Inflammatory Bowel Disease and Skin Cancer: Adherence to Quality Measures

Abstract

Introduction: Previous literature has reported poor documentation related to quality metrics in inflammatory bowel disease (IBD) patients, one of which is skin cancer surveillance. The increased risk for melanoma skin cancer (MSC) in IBD patients has been discussed in the literature prior to biologic therapies becoming available. A recent retrospective cohort study suggested that the use of anti-TNF agents increases the risk of developing MSC. A recent meta-analysis demonstrated a statistically significant 37% increased risk of developing MSC in IBD patients when compared to the general population. In addition, there is a known increased risk of non-MSC in IBD patients who have received thiopurines. In view of this, the American College of Gastroenterology (ACG) has released new clinical guidelines recommending skin cancer screening in IBD patients regardless of the use of biologic therapy. Methods: In an IRB-approved chart review we identified all patients aged 18+ seen at our hospital system between 1/2010 and 12/2015 with ICD-9 diagnosis code for UC (556.xx) or CD (555.xx). An abstraction was used to document clinical history and health maintenance metrics, including skin cancer screening. Characteristics were compared between those with and without skin cancer screening documentation using Chi-square and Wilcoxon Rank-Sum tests. 2-sided p-values of < 0.05 were considered statistically significant. Results: 184 patients were eligible for review (Table 1). The median age 44.5 (IQR 31.6, 58.8), 45% male, 81% white non-Hispanic. The most common diagnostic subtypes were CD penetrating (n=43, 32%), CD inflammatory (n=36, 26.9%) and UC pancolitis (n=29, 22%). About half of the patients (n=100, 54%) were either on a biologic (n=65, 35%) or immunomodulator agent (n=81, 44%). Of these, only 4 (4.0%, 95% CI 1.5%, 10.3%) had documented skin cancer screening (Table 2). Screened patients were older (median 63 years vs. 42 years, p=0.12, Wilcoxon rank-sum), and were more likely to be White (3/4 or 75%) versus Black/AA patients (0/4 or 0.0%) or Hispanic (0/4 or 0.0%) (p < 0.001).Table: Table. Characteristics of Patients in the Study (n=184)Table: Table. Characteristics of Patients on Immunomodulators/Biologics Screened for Skin Cancer vs. NotConclusion: We have conclusive data to support the association between IBD and its pharmacotherapies with an increased risks of skin cancer. It is critical to recognize IBD patients as high risk individuals for developing skin malignancies. Our data is in line with the national trend of poor adherence to skin cancer screening in IBD patients. Adherence to the ACG preventative care guidelines is of supreme importance.