The use of HCT and/or ACE inhibitors significantly increases the risk of non-melanotic skin cancer in the periocular region

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 260; no. 8; pp. 2745 - 2751
• Main Authors: Mehlan, Juliane, Ueberschaar, Julian, Hagenström, K., Garbe, C., Spitzer, M. S., Druchkiv, V., Schuettauf, F.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2022; Springer Nature B.V
• Subjects: Angiotensin-converting enzyme inhibitors; Basal cell carcinoma; Cancer screening; Hydrochlorothiazide; Malignancy; Medical screening; Medicine; Medicine & Public Health; Melanoma; Oculoplastics and Orbit; Ophthalmology; Patients; Peptidyl-dipeptidase A; Photosensitization; Skin cancer; Squamous cell carcinoma; Hypertension; Photosensitization; Basal cell carcinoma; Hydrochlorothiazide; ACE inhibitors; Skin cancer
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-022-05576-y

Background/Aims
To investigate a possible association between the use of hydrochlorothiazide (HCT) and/or angiotensin-converting enzyme inhibitors (ACE inhibitors) and the occurrence of periocular non-melanoma skin cancer.
Methods
The files of 929 patients from the University Medical Center Hamburg-Eppendorf who were surgically treated for suspected periocular malignancy were evaluated retrospectively regarding the occurrence of non-melanoma skin cancer and concomitant medication. To be able to put the data in an overall context, we also analyzed age-matched routine data of the DAK-Gesundheit (DAK-G), a nationwide operating German health insurance company.
Results
Of the 929 patient records examined, who underwent surgical excision for suspected non-melanotic malignancy, non-melanocytic skin cancer could actually be determined by histology in 199 patients. In total, 176 patients (103 women, 72 men) had a basal cell carcinoma and 23 patients (16 women, 7 men) suffered from squamous cell carcinoma. The rate of intake of HCT or ACE inhibitors in our patient collective with non-melanotic skin cancer is significantly higher than in the general age-matched population (ORACE: 2.51,
p
 < 0.001; ORHCT: 7.24,
p
 < 0.001, ORBOTH: 4.61,
p
 < 0.001).
Conclusion
The rate of intake of HCT or ACE inhibitors is significantly higher in our patient collective with non-melanotic skin cancer compared to the group from the age-matched general population (DAK insured (
p
 < 0.001)) compared to the routine data of the DAK-G. This leads us to the conclusion that taking the medication is associated with an increased risk for non-melanotic skin cancer. We recommend regular skin cancer screening, moderate ordination of photosensitizing medication, but above all comprehensive clarification of possible risks.