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Does Hidradenitis Suppurativa Raise Cancer Risk?

Medically reviewed by Diane M. Horowitz, M.D.
Posted on July 20, 2022

Hidradenitis suppurativa (HS), also called acne inversa, is a chronic inflammatory skin condition. It affects as many as 4 percent of people worldwide. HS causes recurrent painful bumps and scars in the armpits, groin, skin folds, and more. HS can also increase your risk of developing certain cancers.

HS and Skin Cancer

Many diseases can occur alongside HS — including cancer. Over the past 20 years, research has consistently found a link between HS and nonmelanoma skin cancers, including squamous cell carcinoma (SCC).

SCC is the second most common type of skin cancer. HS can also lead to basal cell carcinoma, the most common skin cancer. SCC is a rare complication of HS, but it can spread throughout the body and can be deadly.

Many case reports of SCC developing from HS lesions have been published. SCC with HS occurs in men more than women. SCC usually occurs in HS lesions on the buttocks, groin, and perineum. Cases of SCC almost always occur in people who have had HS for many years and who have not been able to manage their symptoms well.

TNF-alpha Inhibitors and SCC

Tumor necrosis factor (TNF)-alpha is a compound produced by the body that contributes to inflammation. TNF-alpha inhibitors — or biologics — treat inflammatory diseases, including HS, inflammatory bowel disease, and inflammatory arthritis.

TNF-alpha inhibitors may increase the risk of certain cancers, including nonmelanoma skin cancer (e.g., SCC). TNF-alpha inhibitors include:

  • Infliximab (Remicade)
  • Etanercept (Enbrel)
  • Certolizumab pegol (Cimzia)
  • Golimumab (Simponi)
  • Adalimumab (Humira)

Some studies have not found a link between these drugs and increased cancer risk, but they did not focus on people with HS. Case reports have shown that some people with HS treated with TNF-alpha inhibitors have developed SCC. These reported cases have involved men with a history of HS for 20 years or more.

Recent research has shown a likely association between nonmelanoma skin cancer and TNF-alpha inhibitors used to treat skin diseases, including HS and psoriasis.

Treatment of SCC

Surgery is the primary treatment for SCC. Early SCC can be treated with minor excisions (similar to skin biopsies) or cryotherapy. More advanced SCC may need more extensive surgery. Depending on the size of the cancer and whether it has metastasized (spread to other organs or parts of the body), radiation and targeted therapy may be used.

HS and Other Types of Cancer

HS has also been linked to increased risk of other cancers besides SCC. Studies have found statistically significant increases in rates of lymphoma (a type of blood cancer) and other cancers, including cancers of the mouth and throat, central nervous system, liver, and colon.

However, some researchers have argued that the risk of developing these cancers is so low that it is not clinically significant.

How Can HS Cause Cancer?

Researchers don’t understand fully how HS increases cancer risk. It is believed to be due to chronic inflammation, a known risk factor for cancer. Acute inflammation is part of the body’s normal response to injury or disease. Some conditions — like HS — can cause chronic, recurrent inflammation without an injury or disease.

In some situations, chronic inflammation can contribute to cancer risk. Over time, chronic inflammation damages healthy tissue and causes cellular damage that can lead to cancer.

Common Cancer Signs and Symptoms

It is important to know the signs and symptoms of cancer, especially if you are at higher risk of developing cancer. It is also important to note that although HS can increase your statistical odds of developing cancer, the risk of developing most types of cancer is still low.

In addition to HS, having other autoimmune or autoinflammatory diseases can increase your risk of cancer. If you have had cancer in the past, you may be at greater risk of cancer due to recurrence or a second cancer. Having a family history of certain cancers can also increase your cancer risk.

General Symptoms

Many types of cancer share similar symptoms. General signs and symptoms of cancer can include:

  • Unexplained weight loss or gain (10 pounds or more)
  • New or unexplained pain
  • The appearance of new lumps, masses, or tumors
  • New or changing skin lesions
  • Fatigue (tiredness not improved by rest)
  • Fever
  • Night sweats
  • Headaches
  • Changes in bowel habits, including blood in your stool
  • Changes in urination, including pain or bleeding
  • Changes in appetite
  • Difficulty swallowing
  • Nausea or vomiting
  • A new, persistent cough
  • Changes to your vision or hearing
  • Unusual bleeding or unexplained bruising

These symptoms are not specific to cancer; they can be caused by many conditions. Always seek medical attention for any unexplained changes to your body or your health.

Nonmelanoma Skin Cancer Symptoms

SCC and basal cell carcinoma have many similar symptoms, including:

  • New or changing skin growths or lesions
  • Skin ulcers (lesions with a raised border and a crusty or bloody indented center)
  • Bumps or nodules that are smooth, shiny, wartlike, or crusted
  • Patches of red skin, sometimes scaly
  • White or yellow scarlike lesions without a previous injury
  • Open sores that do not heal
  • Skin lesions that bleed

If you have any of these symptoms, see a doctor — especially if they occur on or near HS lesions.

What Can You Do To Reduce Your Cancer Risk?

You can take many steps to reduce your risk of developing skin cancer and other cancers.

Some of the most important steps you can take to avoid SCC with HS include:

  • Get appropriate treatment for HS.
  • Stop smoking cigarettes.
  • Lose weight if you are overweight or obese.
  • Follow up with your doctor regularly to monitor your HS.

To prevent cancer in general:

  • Do not use tobacco.
  • Eat a balanced diet with more vegetables and fewer processed foods.
  • Maintain a healthy weight.
  • Get exercise.
  • Avoid excessive sun exposure, use sunscreen, and cover exposed skin.
  • Get vaccinated for hepatitis B and HPV.
  • Avoid risky behaviors by practicing safe sex and not sharing needles.

You Are Not Alone With HS

Hidradenitis suppurativa can be stressful even without an increased risk of skin cancer. You shouldn’t take the risk of skin cancer from HS lightly, but don’t let it fill you with dread or fear either.

Know the signs and symptoms of skin cancer. More importantly, do your best to get your HS symptoms under control. If you are not getting the care you need for your HS, find a doctor or other health care professional with experience treating HS.

You are not alone — you are part of a community whose members can help each other by sharing both positive and negative experiences with HS.

Talk With Others Who Understand

On myHSTeam, the social network for people with hidradenitis suppurativa and their loved ones, more than 26,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Are you living with HS? Have you talked about your skin cancer risk with your health care team? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Hidradenitis Suppurativa — Mayo Clinic
  2. Hidradenitis Suppurativa: A Common and Burdensome, Yet Under-Recognised, Inflammatory Skin Disease — Postgraduate Medical Journal
  3. Comorbidities of Hidradenitis Suppurativa (Acne Inversa) — Dermato-Endocrinology
  4. Incidence of Cancer Among Patients With Hidradenitis Suppurativa — JAMA Dermatology
  5. Neoplastic Implications in Patients Suffering From Hidradenitis Suppurativa Under Systemic Treatments — Biomedicines
  6. Squamous Cell Carcinoma Overview — Skin Cancer Foundation
  7. Cutaneous Squamous Cell Carcinoma — DermNet NZ
  8. Incidence of Skin Cancer in Patients With Chronic Inflammatory Cutaneous Diseases on Targeted Therapies: A Systematic Review and Meta-Analysis of Observational Studies — Frontiers in Oncology
  9. Basal Cell Carcinoma — DermNet NZ
  10. Cutaneous Squamous Cell Carcinoma Complicating Hidradenitis Suppurativa: A Review of the Prevalence, Pathogenesis, and Treatment of This Dreaded Complication — Acta Dermatovenerol Alpina, Pannonica, et Adriatica
  11. Three Fatal Cases of Squamous Cell Carcinoma Arising in Chronic Perineal Hidradenitis Suppurativa — Annals of The Royal College of Surgeons of England
  12. Tumor Necrosis Factor Inhibitors — StatPearls
  13. Cancer Risk With Tumor Necrosis Factor Alpha (TNF) Inhibitors: Meta-Analysis of Randomized Controlled Trials of Adalimumab, Etanercept, and Infliximab Using Patient Level Data — Pharmacoepidemiology and Drug Safety
  14. Risk of Cancer Recurrence Among Individuals Exposed to Anti-Tumor Necrosis Factor Therapy: A Systematic Review and Meta-Analysis of Observational Studies — Journal of Clinical Gastroenterology
  15. Risk of Solid Cancer in Patients Exposed to Anti-Tumour Necrosis Factor Therapy: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis — Annals of the Rheumatic Diseases
  16. Squamous Cell Carcinoma in Hidradenitis Suppurativa Lesions Following Tumor Necrosis Factor α Inhibitors — Cutis
  17. Skin Biopsy — Mayo Clinic
  18. Targeted Therapy — American Cancer Society
  19. Assessment of Overall and Specific Cancer Risks in Patients With Hidradenitis Suppurativa — JAMA Dermatology
  20. Association Between Hidradenitis Suppurativa and Lymphoma — JAMA Dermatology
  21. Incidence of Cancer Among Patients With Hidradenitis Suppurativa — JAMA Dermatology
  22. Overall and Specific Cancer Risks in Patients With Hidradenitis Supperativa — Dermatology
  23. Chronic Inflammation — National Cancer Institute
  24. Inflammation — Cleveland Clinic
  25. Inflammation and Cancer — Nature
  26. Lifetime Risk of Developing or Dying From Cancer — American Cancer Society
  27. Autoimmunity as an Etiological Factor of Cancer: The Transformative Potential of Chronic Type 2 Inflammation — Frontiers in Cell and Developmental Biology
  28. What Is Cancer Recurrence? — American Cancer Society
  29. What Are Second Cancers? — American Cancer Society
  30. Family History of Cancer and the Risk of Cancer: A Network of Case–Control Studies — Annals of Oncology
  31. Signs and Symptoms of Cancer — American Cancer Society
  32. Squamous Cell Carcinoma Warning Signs — Skin Cancer Foundation
  33. Basal Cell Carcinoma Warning Signs — Skin Cancer Foundation
  34. Cancer Prevention: 7 Tips To Reduce Your Risk — Mayo Clinic
Posted on July 20, 2022
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Diane M. Horowitz, M.D. is an internal medicine and rheumatology specialist. Review provided by VeriMed Healthcare Network. Learn more about her here
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here

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