Level of UV Exposure, Skin Type, and Age Are More Important than Thiopurine Use for Keratinocyte Carcinoma Development in IBD Patients

Dig Dis Sci. 2020 Apr;65(4):1172-1179. doi: 10.1007/s10620-019-05818-w. Epub 2019 Sep 6.


Background: Retrospective studies observe an increased risk of keratinocyte carcinomas (KCs) in patients with inflammatory bowel disease (IBD) on thiopurine (TP) medication. The role of traditional risk factors such as skin type and sun protection behavior has not been studied in this population. This study aimed to examine traditional KC risk factors and thiopurine use on skin cancer development in an IBD cohort.

Methods: Consecutive IBD patients were recruited from four specialist centers in Australia and New Zealand, each with varying UV exposure indices. Data pertaining to race, skin color, freckling and sun protection behavior, dose of TP therapy, and skin cancer development were elicited through a self-reported questionnaire.

Results: A total of 691 IBD patients were included with 62 reporting KC development. Thiopurine usage was similar among patients who developed skin cancer compared with those who did not (92% vs. 89%, p = 0.3). There was no statistically significant association between KC development and TP dose or 6-thioguanine nucleotide levels. In multivariate modeling, four factors were independently and significantly associated with KC: age over 61 years old versus less than 30 years old (OR 6.76; 95% CI 2.38-19.18), residing in Brisbane versus Christchurch (OR 3.3; 95% CI 1.6-6.8), never staying in the shade versus staying in the shade ≥ 50% of the time (OR 3.8; 95% CI 1.4-10.5), and having a skin type that never tanned versus other skin types (OR 6.9; 95% CI 2.9-16.0).

Conclusion: Skin type, age, and sun protection behavior are more important risk factors for KC development than thiopurine medication use in this IBD population.

Keywords: Immunosuppression; Inflammatory bowel disease; Skin cancer.

Publication types

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

MeSH terms

  • Adult
  • Age Factors
  • Australia / epidemiology
  • Azathioprine / adverse effects
  • Azathioprine / pharmacology
  • Azathioprine / therapeutic use
  • Cohort Studies
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / pharmacology
  • Immunosuppressive Agents / therapeutic use*
  • Inflammatory Bowel Diseases / drug therapy
  • Inflammatory Bowel Diseases / epidemiology*
  • Keratinocytes / drug effects
  • Keratinocytes / pathology
  • Keratinocytes / radiation effects*
  • Male
  • Middle Aged
  • New Zealand / epidemiology
  • Risk Factors
  • Skin / drug effects
  • Skin / radiation effects
  • Skin Neoplasms / chemically induced
  • Skin Neoplasms / epidemiology*
  • Skin Neoplasms / etiology
  • Skin Pigmentation / drug effects
  • Skin Pigmentation / physiology
  • Skin Pigmentation / radiation effects*
  • Ultraviolet Rays / adverse effects*


  • Immunosuppressive Agents
  • Azathioprine