Risk of non-melanoma skin cancer in a national cohort of veterans with rheumatoid arthritis

Rheumatology (Oxford). 2011 Aug;50(8):1431-9. doi: 10.1093/rheumatology/ker113. Epub 2011 Mar 16.


Objective: To determine the incidence of and risk factors for non-melanoma skin cancer (NMSC) in a national cohort of veterans with RA.

Methods: We examined skin cancer risk in a cohort of 20 648 patients with RA derived from the Department of Veterans' Affairs (VA) national administrative databases. The cohort was divided into two medication groups: patients treated with non-biologic and TNF-α antagonist DMARDs. We defined skin cancer as the first occurrence of an International Classification of Disease, Version 9, Clinical Modification (ICD-9-CM) code for NMSC after initiation of a DMARD. Outcome risk was described using hazard ratios (HRs) with Cox proportional hazards regression for time-to-event analysis and logistic regression. We performed medical record review to validate the diagnosis of NMSC.

Results: Incidence of NMSC was 18.9 and 12.7 per 1000 patient-years in patients on TNF-α antagonists and non-biologic DMARDs, respectively. Patients on TNF-α antagonists had a higher risk of developing NMSC (HR 1.42; 95% CI 1.24, 1.63). Risk factors for NMSC included older age, male gender, NSAID and glucocorticoid use and a history of prior malignancies. There was substantial agreement between ICD-9-CM diagnosis of NMSC and medical record validation (κ = 0.61).

Conclusion: TNF-α antagonist therapy in veterans with RA may be associated with an increased risk of NMSC, compared with therapy with non-biologic DMARDs. Rheumatologists should carefully screen patients receiving TNF-α antagonists for pre-cancerous skin lesions and skin cancer.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Arthritis, Rheumatoid / epidemiology*
  • Arthritis, Rheumatoid / pathology
  • Carcinoma, Basal Cell / epidemiology*
  • Carcinoma, Basal Cell / pathology
  • Carcinoma, Squamous Cell / epidemiology*
  • Carcinoma, Squamous Cell / pathology
  • Comorbidity
  • Databases, Factual
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Skin Neoplasms / epidemiology*
  • Skin Neoplasms / pathology
  • United States / epidemiology
  • Veterans Health* / statistics & numerical data