# Soriasis--A Cancer Risk Factor?
## 1 Introduction  
Soriasis is a chronic immune-mediated inflammatory disease that affects 2-3% of the world population; in Europe the prevalence rates range from 0.73% (in Scotland) to 2.9% (in Italy) [1]. Currently, it is no longer considered strictly a skin condition but a complex disease with multisystem involvement due to the frequent associated comorbidities. Additionally, as psoriasis affects patients' physical appearance, the disease often has a psychological impact.  
Comorbidities of psoriasis are a topical issue of modern dermatology, the literature suggesting the association of the severe forms with an increased incidence of cardiovascular diseases, metabolic syndrome, diabetes, depression, and cancer [2, 3].  
Two meta-analyses including several studies [4, 5] were aimed at estimating the risk of cancer in patients with psoriasis. The first meta-analysis [4] showed that psoriasis patients are at slightly increased risk for developing solid organ cancer (upper aerodigestive tract, liver, lung, pancreas, and urinary tract), increased risk for squamous cell carcinoma and basal cell carcinoma, without increasing the risk for melanoma, and with regard to lymphoma, the misdiagnosis of primary cutaneous lymphoma as psoriasis would have overestimated the risk. In the most recent meta-analysis [5], the results partially coincide with those reported by the first meta-analysis, suggesting a possible risk for colorectal, upper aerodigestive tract, kidney cancers, lymphomas, keratinocyte, esophageal, and pancreatic cancers. Additionally, the overall risk of cancer mortality was higher in patients with severe psoriasis.  
Previous studies evaluating the risk of developing cancer in patients with psoriasis are contradictory. A study conducted in the United States reported a 78% increase intotal cancer risk for patients with severe psoriasis (treated with systemic drugs) and by 13% for those with mild disease compared to the control group including hypertensive patients without psoriasis [6]. Another perspective was opened by [PERSON] et al. [7] who investigated an association between psoriasis and cancer after adjusting for risk factors. In this study, 55% of the psoriasis patients were younger than 50 years at diagnosis of psoriasis and had a slight increase in the total cancer rate.  
The biological mechanism that explains the relationship between psoriasis and cancer is under investigation. The hypotheses underlying the possible risk of malignancy among the psoriasis population are the disease itself due to its inflammatory nature, the use of immunosuppressive medication, biologic therapy, exposure to ultraviolet (UV) therapies, or the association of lifestyle factors (smoking, alcohol, diet) [8]. However, so far there is no consensus whether these patients need a cancer screening or prevention program.  
The present study aims to:  
* Provide descriptive epidemiological data on the association of psoriasis with malignancies in Northeastern Romania;
* Quantify the risk of developing different forms of cancer in patients with psoriasis compared to the general population;
* Analyze a possible benefit of implementing a cancer screening/prevention program in patients with psoriasis.