Original article
Systematic reviews and meta-analyses
Inflammatory Bowel Disease Is Associated With an Increased Risk of Melanoma: A Systematic Review and Meta-analysis

https://doi.org/10.1016/j.cgh.2013.04.033Get rights and content

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.

Section snippets

Methods

This systematic review was conducted following guidance provided by the Cochrane Handbook13 and Kanwal and White14 and was reported according to the Meta-analysis Of Observational Studies in Epidemiology guidelines.15

Results

Of 838 potential studies identified, 12 studies fulfilled all inclusion criteria and were included in the meta-analysis.5, 6, 7, 8, 12, 23, 24, 25, 26, 27, 28, 29 These cumulatively reported 179 cases of melanoma in 172,837 patients with IBD (92,208 with CD, 79,360 with UC, and 1269 unclassified). One hospital-based study was excluded because the data were not sufficient to estimate the SIR.30 One study performed in Olmsted County, Minnesota, was published only in abstract form, but additional

Discussion

Unlike nonmelanoma skin cancers, which usually are amenable to local resection and have excellent cure rates and long-term survival, melanoma is associated with greater morbidity and mortality, with prognosis highly dependent on depth of invasion.31 The 10-year survival of patients with tumor depth less than 0.5 mm is 96%, as compared with 54% for patients with tumor depth of 4 to 6 mm.32 Identifying patients at high risk for this disease would allow appropriate surveillance, enabling early

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    Conflicts of interest This author discloses the following: Edward Loftus has consulted for and has received research support from Janssen Biotech, Abbott Laboratories, and UCB Pharma. The remaining authors disclose no conflicts.

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