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P352. Screening for melanoma and non melanoma skin cancer in IBD patients before treatment with thiopurines and anti-TNFs: A prospective cohort study

E. Lolli1, R. Saraceno2, C. Petruzziello1, G. Condino1, M. Ascolani1, A. Ventura2, A. Capanna1, A. Ruffa1, S. Onali1, E. Calabrese1, S. Chimenti2, F. Pallone1, L. Biancone1, 1Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy, 2Dermatology Unit, University of Rome Tor Vergata, Systems Medicine, Rome, Italy

Background

In Inflammatory Bowel Disease (IBD), an increased risk of skin cancer has recently been reported, when using thiopurines (Non Melanoma Skin Cancer, NMSC) or anti-TNFs (melanoma). In a prospective study, we aimed to assess the frequency of NMSC and melanoma in a cohort of IBD patients (pts) screened for skin cancer before thiopurines (IMM) or anti-TNFs.

Methods

From January 2012 to April 2013, consecutive IBD pts in follow up with indication for thiopurines or anti-TNFs treatments were screened by one experienced dermatologist. Dermatological assessment focused in detecting NMSC or melanoma was performed before (T0), at 6 (T6) and 12 mos (T12) after IMM. Results were expressed as median (range).

Results

Dermatological screening has been performed in 61 IBD pts (32 M, age 42, range 20–70; IBD duration 7 yrs, range 1–30). The IBD group included 15 UC (9 M, age 39, range 23–70; duration 6 yrs, range 1–17; UC distal 2, left 2, extensive 11) and 46 CD (23 M, age 42, range 20–67; duration 8.5 yrs, range 1–30; CD colitis 2, ileo-colitis 10, ileitis 13, neo-terminal ileum 21). Combined therapy (1 azathioprine, AZA + Infliximab, IFX; 2 AZA + adalimumab, ADA) was given after screening to 3/61 (5%) pts. Monotherapy included AZA in 26/61 (43%) IBD (7 UC, 19 CD), 6-mercaptopurine in 2/61 (3%) IBD (1 UC, 1 CD) and anti-TNFs in 36/61 (59%) pts (8 UC, 28 CD), including IFX in 18/61 (29%) (6 UC, 12 CD), ADA in 18/61 (29%) pts (2 UC, 16 CD). Before IMM, NMSC was diagnosed in 1/61 (1.6%) pts, while no cases of melanoma were diagnosed. At T0, all pts were treated with local photolyase aimed to prevent skin cancer. At T6, dermatological assessment has already been performed in 19/61 (31%) pts, as 8 (13%) discontinued treatments (intolerance in 7: AZA 5, ADA 1, IFX 1; pregnancy in 1, IFX); 2 (3%) were lost to follow up; 2 (3%) died (cirrhosis or sepsis), while 30 (49%) pts are continuing the follow up. At T12, 45/61 (74%) pts are in follow up; in 1 (2%) pt no lesions were detected, while 4/61 (7%) pts discontinued IMM due to intolerance (1 AZA, 2 ADA, 1 IFX). No cases of NMSC or melanoma were detected at 6 or 12 mos (1 NMSC detected at T0).

Conclusion

In a cohort of IBD patients from a Mediterranean area, dermatologic screening before immunomodulators showed a low frequency of NMSC and no melanoma. Dermatologic screening and photoprotection are however suggested during immunomodulatory treatments in IBD patients, at higher risk of skin cancer.