Methotrexate Therapy in Psoriasis Increases Nonmelanoma Skin Cancer Risk

skin cancer dermoscopy
Female dermatologist (30s, mixed race, Asian / Caucasian) examining male patient (30s) with dermascope, looking for signs of skin cancer. Focus on woman.
A study shows 7.8% of patients with psoriasis who were treated with methotrexate developed nonmelanoma skin cancer.

The following article is part of our coverage of the American Academy of Dermatology’s annual meeting (AAD 2021) that is being held virtually from April 23-25, 2021. Dermatology Advisor‘s staff will report on the top research in dermatologic advances and clinical care. Check back for the latest news from AAD 2021.


Patients with psoriasis treated with methotrexate have a significantly increased risk for developing nonmelanoma skin cancers, according to study results presented at the American Academy of Dermatology’s Virtual Meeting Experience (AAD VMX) 2021, held online from April 23 to April 25, 2021.

Current data and literature regarding the relationship between psoriasis, methotrexate therapy, and nonmelanoma skin cancers is “not well quantified,” it was noted. To further evaluate this risk, researchers conducted a systemic review of literature published through June 2019. This search included prospective or retrospective observational and case control studies that compared patients with psoriasis on methotrexate therapy with patients not on methotrexate therapy.

In total, 1301 studies were identified; 9 met the inclusion criteria (4 case-control and 5 cohort studies) with a total patient population of 11,875 individuals with psoriasis. Within this population, 2192 were taking methotrexate therapy and 9683 were not. In the methotrexate group, 7.8% of patients developed nonmelanoma skin cancer, compared with 1.2% of patients in the nonmethotrexate group.

A meta-analysis identified that patients with psoriasis treated with methotrexate have a 2.8-times higher chance of developing nonmelanoma skin cancer than patients using other treatments (95% CI, 1.47-5.39; P =.002). Heterogeneity of the data was moderate (I2=42.6%).

Study limitations include a small number of high-quality investigational studies available for review and the inclusion of all patients taking methotrexate, even those on concurrent biologic or phototherapy regimens.

“Patients with psoriasis who are on [methotrexate] are at a significantly increased risk for developing [nonmelanoma skin cancers],” the researchers concluded. “Proper education and counseling regarding this risk would be important to reduce morbidity and improve health care outcomes in patients with psoriasis.”

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Lang ME, Stewart J, Erwin PJ, Brewer JD. Psoriasis and methotrexate: A systematic review and meta-analysis of nonmelanoma skin cancer risk. Presented at: AAD VMX 2021; April 23-25, 2021. Abstract/Poster 27978.