PHILADELPHIA — Past research has cautioned about the risk of skin cancer with use of immunosuppressive medications. Yet, a new study pointed out, there is limited information on repeated basal cell cancer (BCC) occurrences among inflammatory bowel disease (IBD) patients, especially those who use immunosuppressive medications.

An article in the American Journal of Gastroenterology recently discussed the retrospective cohort study of 54,919 patients with IBD followed in the VA Healthcare System.1

The Corporal Michael J. Crescenz VAMC-led researchers identified patients who had an incident BCC after their IBD diagnosis. Patients’ exposure based on their IBD medications use was defined as:

  1. only aminosalicylate (5-ASA) use,
  2. only active thiopurine (TP) use,
  3. past TP use (discontinued >6 months ago) and no antitumor necrosis factor (TNF) use,
  4. anti-TNF use after previous TP use,
  5. only anti-TNF use, and
  6. active anti-TNF and TP use.

Researchers were focused on the repeated occurrence of BCC and used adjusted and unadjusted hazard ratios with 95% confidence intervals to estimate the risk of repeated BCC occurrence.

Results indicated that 518 patients developed BCC after their IBD diagnosis. The numbers of repeated BCC occurrences per 100 person-years were 12.8 (5-ASA use only), 34.5 (active TP use), 19.3 (past TP use and no anti-TNF use), 25.4 (anti-TNF use after previous TP use), 17.8 (only anti-TNF use), and 22.4 (active anti-TNF and TP use).

“Compared with 5-ASA use alone, only active TP use was associated with an increased risk for repeated BCC occurrence (adjusted hazard ratio 1.65, 95% confidence interval 1.24-2.19; P = 0.0005),” the authors wrote. “However, the increased risk was no longer present for other exposure categories.”

The researchers concluded that, among IBD patients who developed an incident BCC while taking a TP and continued it, there was an increased risk of repeated BCC occurrences.


  1. Khan N, Patel D, Trivedi C, et al. Repeated Occurrences of Basal Cell Cancer in Patients With Inflammatory Bowel Disease Treated With Immunosuppressive Medications. Am J Gastroenterol. 2020;115(8):1246-1252. doi:10.14309/ajg.0000000000000679