- Matthew Vesely, MD, PhD
- Comorbidities, Expert Insights
- There may be a small increased risk of cancer in patients with psoriasis, primarily skin cancer and lymphomas.
- The cause of the increased risk remains unknown but is likely due to comorbidities and lifestyle factors.
- Current treatments for psoriasis do not increase the risk of cancer and, in many cases, may reduce risk.
- Psoriasis patients with a history of cancer or those with active cancer may be safely treated with most available therapies.
Psoriasis and Cancer: What is the Risk?
Psoriasis is a chronic inflammatory disease of the skin and joints with associated comorbidities, including obesity and cardiovascular disease1. Given that systemic inflammation can, in some cases, contribute to cancer development2, there have been several studies examining the risk of cancer development in patients with psoriatic disease 3-8. Many of these studies have shown that patients with psoriasis have a slightly increased risk of cancer. However, the risk appears isolated to certain cancers, including squamous cell carcinomas (SCC), basal cell carcinoma (BCC), and lymphomas5. A meta-analysis involving 112 studies that included over 2 million patients with psoriasis or psoriatic arthritis found that people with psoriasis have a minimal increased risk of developing cancer, with a relative risk (RR) of 1.215. The same study by Vaengebjerg et al.5, found no increased risk of cancer development in patients with psoriatic arthritis (RR 1.02). A separate meta-analysis of 20 cohort studies that included 851,942 patients with psoriasis and 7,974,047 controls showed no significant increased risk of malignancy with a hazard ratio (HR) of 1.029. Collectively, these studies demonstrate there may be a small increased risk of certain cancers for patients with psoriasis. However, it is unclear if this increased risk of cancer is due to chronic inflammation, lifestyle, comorbidities, or earlier treatments for psoriasis. Prior to biologic therapy and the use of narrow-band ultraviolet B (nbUVB) light therapy, psoriasis treatments such as psoralen and UVA (PUVA) and cyclosporin increased the risk of malignancies, particularly SCCs10,11.
Risk of Cancer with Therapy for Psoriasis
As mentioned above, traditional treatments for psoriasis that included PUVA and cyclosporin increased the risk of cancer. Moderate to severe psoriasis is often treated with immunomodulatory biologic drugs or small-molecule inhibitors. In the study by Vaengebjerg et al5, patients with psoriasis treated with biologics did not have an increased risk of developing cancer (RR 0.97). Based on these results, there was a decrease in risk of malignancy when comparing patients with psoriasis (RR 1.21) to those with psoriasis treated with biologics (RR 0.97). Specifically, studies have demonstrated that biologic drugs targeting TNFa12,13, IL-17A14,15, and IL-2316 do not increase the risk of cancer development in patients with psoriasis. Additional studies have also shown that biologic therapy does not increase the risk of cancer17 and may reduce the risk of cancer development in patients with psoriasis18,19. It is tempting to speculate that the reduction of chronic inflammation results in the observed reduced risk, but more data is needed to reach a firm conclusion.
Nevertheless, the data is very reassuring that biologic therapy is safe and does not significantly increase the risk of cancer. Apremilast has not shown an increased risk of malignancy in patients with psoriasis20. There is less data about TYK2 inhibition and the risk of malignancy. The mechanism of action suggests a low risk of cancer development, and a recent analysis of 3-year safety data from pooled Phase 3 trials of deucravacitinib shows no increased incidence of malignancies21.
Psoriasis Treatment in Patients with a History of Cancer
In patients with a history of cancer, biologic therapy does not increase the risk of new or recurrent cancers22. As cancer is a complex and heterogeneous disease, there are evolving guidelines to select the appropriate psoriasis therapy for patients with a history of cancer23,24. Based on EuriGuiDerm guidelines for treating psoriasis patients with a history of cancer, there is a strong consensus to recommend nbUVB and acitretin followed by methotrexate, apremilast, and biologics targeting TNF, IL-17, and IL-2324. The selection of an individual therapy will depend on the patient’s comorbidities. Consensus guidelines do not recommend the use of cyclosporin in psoriasis patients with a previous history of cancer, especially SCC23,24.
Psoriasis Treatment in Patients with Active Cancer
There are few studies examining the impact of psoriasis treatment in patients who have active cancer and are undergoing cancer therapy. However, recent studies have shown that many psoriasis treatments are safe for cancer patients, including nbUVB, acitretin, apremilast, and biologics targeting TNF, IL-17, and IL-2325-28. Larger studies are needed to confirm these smaller studies. Immunotherapy of cancer with immune checkpoint inhibitors can increase psoriasis development and flares29. Fortunately, similar systemic therapies can be used effectively without interrupting cancer therapy, including acitretin, apremilast, and biologics targeting TNF, IL-17, and IL-2330.
Final Thoughts
In caring for patients with psoriasis, it is essential to consider the entire medical history of an individual and formulate a patient-centered treatment plan. Although there is conflicting data on the risk of psoriasis patients developing cancer, yearly skin exams by a dermatologist seem prudent based on the potential increased risk of skin cancers. Fortunately, many psoriasis treatments have excellent safety data and do not increase the risk of cancer development, and are safe to use in patients with a history of cancer or those actively undergoing cancer treatment.
References
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- Greten FR, Grivennikov SI. Inflammation and Cancer: Triggers, Mechanisms, and Consequences. Immunity. Jul 16 2019;51(1):27-41. doi:10.1016/j.immuni.2019.06.025.
- Margolis D, Bilker W, Hennessy S, Vittorio C, Santanna J, Strom BL. The Risk of Malignancy Associated with Psoriasis. Arch Dermatol. Jun 2001;137(6):778-83.
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- Lebwohl M, Deodhar A, Griffiths CEM, et al. The Risk of Malignancy in Patients with Secukinumab-treated Psoriasis, Psoriatic Arthritis and Ankylosing Spondylitis: Analysis of Clinical Trial and Postmarketing Surveillance Data with up to Five years of Follow-up. Br J Dermatol. Nov 2021;185(5):935-944. doi:10.1111/bjd.20136
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- Mease PJ, Hatemi G, Paris M, et al. Apremilast Long-Term Safety Up to 5 Years from 15 Pooled Randomized, Placebo-Controlled Studies of Psoriasis, Psoriatic Arthritis, and Behcet’s Syndrome. Am J Clin Dermatol. Sep 2023;24(5):809-820. doi:10.1007/s40257-023-00783-7.
- Merola JF, Ferris LK, Sobell JM, et al. Deucravacitinib: Adverse Events of Interest Across Phase 3 Plaque Psoriasis Trials. Dermatol Ther (Heidelb). Feb 2025;15(2):453-462. doi:10.1007/s13555-025-01337-x.
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