# Soriasis--A Cancer Risk Factor?
## 4 Discussion
Cyclosporine is a calcineurin inhibitor that inhibits inflammation by blocking the production of IL-2 by activated CD4+ cells. It has been shown to significantly increase the risk of NMSC in patients with psoriasis and rheumatoid arthritis (RA) [15; 49]. However, a review of 60 studies including over 1700 cyclosporine-treated psoriasis patients did not document skin cancer when cyclosporine was used continuously for less than 6 months or less than 2 years if used intermittently [50]. Methotrexate is an affordable and effective drug and is considered the gold standard for RA and psoriasis treatment. The consequences of its systemic immunosuppression in the development of cancer have been debated, and the results are contradictory. Although the association with melanoma and Epstein-Barr virus-associated lymphomas has been reported [51], a subsequent meta-analysis did not indicate an increased risk of lymphoma or other malignancy in patients treated with methotrexate [52]. However, a 2010 systematic review by [PERSON] et al. suggested that methotrexatein combination with anti-TNF may increase the risk of melanoma and double the risk for NMSC [53]. As acitretin does not increase the risk of solid organ cancer and is beneficial in treating NMSC and cutaneous T-cell lymphoma, some authors advocate prescribing it alone or in combination with biologics, phototherapy, or systemic therapies [43]. The introduction of effective biological therapies for psoriasis has revolutionized the therapeutic approach by obtaining fast, satisfactory and persistent results. The problem of their association with various types of cancers has been raised. A recent meta-analysis [54] that included databases from Israel, Spain, Italy, U.K. and Ireland has shown that cumulative exposure to various biological therapies in psoriasis patients does not increase the risk of cancer. In another meta-analysis aimed strictly at anti-TNF therapy, it does not appear to be linked to a higher risk of cancer [55]. A review of eight cohort studies on TNF inhibitors, except for one study on unstekinumab, showed an increase in NMSC, especially SCC, in the TNF inhibitor group compared with both a general US population and a population of rheumatoid arthritis treated with TNF inhibitors, without increasing the risk of developing other cancers [56]. For the state-of-the-art biological molecules, such as IL-12/23, IL17, data are insufficient and the time since their introduction is relatively short for analyzing the risk of developing malignancies  
The prognosis of patients with psoriasis was a topic of interest. A cohort study in the United Kingdom showed a slightly increased risk of cancer deaths, but this increase was modest compared to the risk of cardiovascular death among patients with severe psoriasis [57]. Another cohort study showed a worse prognosis for psoriasis patients diagnosed with cancer before the age of 65 and for those who received treatment for conditions related to ethanol consumption. Additionally, those with more than one hospitalization for psoriasis were more likely to be associated with an increased risk for cancer-specific mortality [58]. A retrospective case-control study aimed at determining the risk of melanoma and blood cancers in patients with psoriasis compared with a control group without psoriasis did not show differences in prognosis [59]. Smoking, alcohol consumption and obesity are independent risk factors for psoriasis, and they are also cancer-enhancing factors. In addition, previous exposure to immunosuppressive medication and ultraviolet radiation appears to increase the risk of cancer. Thus, for dermatologists' risk-benefit assessment of systemic immunosuppressive treatment and PUVA is a dynamic process [60].