TOPLINE

Systemic lupus erythematosus (SLE) is associated with an increased risk for actinic keratosis (AK) and squamous cell carcinoma in situ (SCCIS), but not invasive keratinocyte carcinomas. Patients with comorbid discoid or subacute cutaneous lupus erythematosus showed an elevated risk for both precursor lesions and invasive squamous cell carcinoma (SCC).

METHODOLOGY

• Researchers conducted a retrospective cohort study using electronic health record (EHR) data from the Mass General Brigham Research Patient Data Registry in the US, spanning 1996-2025.
• A total of 17,390 adults with incident SLE and matched individuals were included.
• Individuals with prior AK, SCCIS, or keratinocyte carcinoma were excluded from the analysis.
• Outcomes included the first AK, SCCIS, SCC, and basal cell carcinoma (BCC) diagnosis, as well as time from AK to SCC.
• Follow-up was censored at 25 years for AK, SCCIS, and AK-to-SCC analyses, and at 30 years for SCC and BCC analyses.

TAKEAWAY

• Overall, SLE was associated with an increased risk for AK (hazard ratio [HR], 1.50; 95% CI, 1.37-1.64) and SCCIS (HR, 1.87; 95% CI, 1.51-2.32), but not invasive SCC or BCC.
• Patients with comorbid discoid or subacute cutaneous lupus erythematosus (n = 1689) exhibited increased risks for AK (HR, 2.13; 95% CI, 1.63-2.79), SCCIS (HR, 2.78; 95% CI, 1.44-5.36), and SCC (HR, 1.81; 95% CI, 1.05-3.12) compared with matched individuals.
• Among individuals who developed AK, SLE was associated with a prolonged interval to subsequent SCC diagnosis (HR, 0.66; 95% CI, 0.50-0.88).
• Glucocorticoids were associated with an increased risk for SCC (HR, 1.28; P < .05), azathioprine (HR, 1.57; P < .05) and mycophenolate (HR, 1.63; P < .05) were associated with an increased risk for BCC, and calcineurin inhibitors were associated with increased risks for both SCC (HR, 2.20; P < .05) and BCC (HR, 2.22; P < .05).

IN PRACTICE

“This study supports heightened AK and SCCIS risk in SLE and highlights the importance of cutaneous disease phenotype and immunosuppressive exposure when assessing individual keratinocyte carcinoma risk,” the authors of the study wrote.

SOURCE

The study was led by Angela E. Zou, PhD, Harvard Medical School, and Shadmehr Demehri, MD, PhD, Massachusetts General Hospital, Boston. It was published online as a brief report in the Journal of the American Academy of Dermatology.

LIMITATIONS

Study limitations include the lack of data on SLE disease severity, medication dosages, and ultraviolet exposure, which could influence keratinocyte carcinoma risk. Additionally, AK burden and treatment intensity could not be fully quantified, although field therapy use was similar between cohorts. The retrospective design and reliance on EHR data may introduce coding inaccuracies or incomplete capture of diagnoses.

DISCLOSURES

The study was supported by awards from the National Institute of General Medical Sciences and the Burroughs Wellcome Fund. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.