Thiopurines and non-melanoma skin cancer: partners in crime in inflammatory bowel diseases.

Abstract

Several studies have shown that inflammatory bowel diseases (IBD) patients treated with thiopurines have an increased risk of developing skin cancer. This review is based on recent published literature regarding the use of thiopurines in IBD and skin malignancies. Exposure to thiopurines is significantly associated with nonmelanoma skin cancer, but not with melanoma. Primary and secondary prevention including sun-protective measures and regular dermatologic screening are recommended in IBD patients, particularly in those exposed to thiopurines. Both when and how immunosuppressive therapy should be resumed in patients with a prior history of skin cancer still remain debatable topics. The benefit-risk balance between thiopurine therapy and risk of skin cancer should be evaluated in the drug decision process. The approval of new effective strategies requires the re-evaluation of the positioning of thiopurines within the therapeutic algorithm based on an increasingly individualized approach.