Skin cancer risk in patients with non-dermatologic immune-mediated inflammatory diseases

Safety issues related to the risk of cancer associated with immune-mediated inflammatory disease (IMID) treatments have always been a major concern. Skin cancer is the most common type of cancer, especially non-melanoma skin cancer (NMSC), with a steadily increasing incidence. Some guidelines recommend that all patients with IMID should undergo regular skin cancer screening due to a combination of treatment-related and disease-related risk factors. However, systematic skin cancer screening is still controversial because there is no substantial evidence that it reduces skin cancer mortality. Furthermore, dermatologists have insufficient resources to screen all IMID patients and need, therefore, to focus on at-risk patients. Such screening could also lead to overdiagnosis. In this review, we will summarise the data on the risk of skin cancer in patients with non-dermatologic IMID according to treatment. We will also propose an algorithm to help the clinician focus on those patients most needing annual skin screening.