Level of UV Exposure, Skin Type, and Age Are More Important than Thiopurine Use for Keratinocyte Carcinoma Development in IBD Patients

  • Yang WuEmail author
  • Simon Ghaly
  • Stephen Kerr
  • Bryce Jackson
  • Katherine Hanigan
  • Deborah Martins
  • Krupa Krishnaprasad
  • Reme E. Mountifield
  • David C. Whiteman
  • Peter A. Bampton
  • Richard B. Gearry
  • Graham L. Radford-Smith
  • Ian C. Lawrance
Original Article



Retrospective studies observe an increased risk of keratinocyte carcinomas (KCs) in patients with inflammatory bowel disease (IBD) on thiopurine (TP) medication. The role of traditional risk factors such as skin type and sun protection behavior has not been studied in this population. This study aimed to examine traditional KC risk factors and thiopurine use on skin cancer development in an IBD cohort.


Consecutive IBD patients were recruited from four specialist centers in Australia and New Zealand, each with varying UV exposure indices. Data pertaining to race, skin color, freckling and sun protection behavior, dose of TP therapy, and skin cancer development were elicited through a self-reported questionnaire.


A total of 691 IBD patients were included with 62 reporting KC development. Thiopurine usage was similar among patients who developed skin cancer compared with those who did not (92% vs. 89%, p = 0.3). There was no statistically significant association between KC development and TP dose or 6-thioguanine nucleotide levels. In multivariate modeling, four factors were independently and significantly associated with KC: age over 61 years old versus less than 30 years old (OR 6.76; 95% CI 2.38–19.18), residing in Brisbane versus Christchurch (OR 3.3; 95% CI 1.6–6.8), never staying in the shade versus staying in the shade ≥ 50% of the time (OR 3.8; 95% CI 1.4–10.5), and having a skin type that never tanned versus other skin types (OR 6.9; 95% CI 2.9–16.0).


Skin type, age, and sun protection behavior are more important risk factors for KC development than thiopurine medication use in this IBD population.


Immunosuppression Inflammatory bowel disease Skin cancer 



This work was supported by an educational grant from Abbvie. David Whiteman has received Research Fellowship (APP1058522) from the National Health and Medical Research Council of Australia (NHMRC).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

10620_2019_5818_MOESM1_ESM.pdf (2.4 mb)
Supplementary material 1 (PDF 2406 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Yang Wu
    • 1
    Email author
  • Simon Ghaly
    • 1
  • Stephen Kerr
    • 2
  • Bryce Jackson
    • 3
  • Katherine Hanigan
    • 4
  • Deborah Martins
    • 4
    • 5
  • Krupa Krishnaprasad
    • 4
  • Reme E. Mountifield
    • 6
  • David C. Whiteman
    • 7
  • Peter A. Bampton
    • 6
  • Richard B. Gearry
    • 3
  • Graham L. Radford-Smith
    • 4
    • 8
    • 9
  • Ian C. Lawrance
    • 10
    • 11
  1. 1.Department of GastroenterologySt Vincent’s HospitalDarlinghurst, SydneyAustralia
  2. 2.Kirby InstituteSydneyAustralia
  3. 3.Department of GastroenterologyChristchurch HospitalChristchurchNew Zealand
  4. 4.IBD Research GroupQIMR Berghofer Medical Research InstituteBrisbaneAustralia
  5. 5.Division of Plastic and Reconstructive SurgeryUniversity of California San FranciscoSan FranciscoUSA
  6. 6.Department of GastroenterologyFlinders Medical CentreAdelaideAustralia
  7. 7.Cancer Control GroupQIMR Berghofer Medical Research InstituteBrisbaneAustralia
  8. 8.Department of GastroenterologyRoyal Brisbane and Women’s HospitalBrisbaneAustralia
  9. 9.University of Queensland School of MedicineBrisbaneAustralia
  10. 10.Centre of Inflammatory Bowel DiseasesSt John of God HospitalSubiacoAustralia
  11. 11.School of Medicine and Pharmacology, Harry Perkins Institute of Medical ResearchUniversity of Western AustraliaMurdochAustralia

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