PracticeUpdate
Research · February 01, 2014
TAKE-HOME MESSAGE
- This systematic review and meta-analysis found the risk of melanoma in patients with inflammatory bowel disease (IBD) to be 37% higher than that in the general population. This increased risk was independent of either immunomodulator or anti–TNF-α treatment.
- Given the known risk for nonmelanoma skin cancers in patients with IBD, this new information regarding increased melanoma risk supports the need for skin cancer screening in these patients as well as primary prevention through sun protection.
ABSTRACT
BACKGROUND & AIMS
Inflammatory bowel disease (IBD) has been associated with an increased risk of nonmelanoma skin cancer, particularly among patients treated with thiopurines. It is unclear whether IBD affects risk for melanoma. We performed a systematic review and meta-analysis of cohort studies to determine the risk of melanoma in patients with IBD.
METHODS
We conducted a systematic search of bibliographic databases through March 2013. Cohort studies reporting incident melanoma after IBD diagnosis and an estimate of incidence rate ratio or standardized incidence rate were included in the analysis. Pooled relative risk (RR) estimates with 95% confidence intervals (CIs) were calculated using the random-effects model.
RESULTS
Our analysis included 12 studies, comprising a total of 172,837 patients with IBD; 179 cases of melanoma were reported from 1940 to 2009. The pooled crude incidence rate of melanoma in patients with IBD was 27.5 cases/100,000 person-years (95% CI, 19.9–37.0). Overall, IBD was associated with a 37% increase in risk of melanoma (12 studies: RR, 1.37; 95% CI, 1.10–1.70). The risk was increased among patients with Crohn’s disease (7 studies: RR, 1.80; 95% CI, 1.17–2.75) and ulcerative colitis (7 studies: RR, 1.23; 95% CI, 1.01–1.50). The risk of melanoma was higher in studies performed before introduction of biologic therapies (before 1998) (8 studies: RR, 1.52; 95% CI, 1.02–2.25) but not in studies performed after 1998 (2 studies: RR, 1.08; 95% CI, 0.59–1.96).
CONCLUSIONS
Based on a meta-analysis, IBD has been associated with an increased risk of melanoma, independent of the use of biologic therapy. Patients diagnosed with IBD should be counseled on their risk for melanoma.