What You Should Know About Hidradenitis Suppurativa and Skin Cancer

“If left untreated, squamous cell cancer can become locally invasive, aggressive, and destructive to the skin and nearby tissue,” says Farah Succaria, MD, an assistant professor of dermatology at Johns Hopkins University School of Medicine in Baltimore. In other words, it can metastasize (spread) and cause serious and potentially fatal damage.­

Again, SCC is most often caused by too much sun exposure. This may sometimes be the case for people with HS who develop SCC in areas of skin that aren’t typically hidden in skin folds or by clothing. Other factors, including chronic inflammation and immunosuppression, may also play a role in how squamous cell cancer occurs and behaves when it’s associated with HS.

A chief concern is inflammation, which can make any type of cancer worse, says Luis Andres Garza, MD, PhD, a professor of dermatology at Johns Hopkins University School of Medicine in Baltimore. The inflammation that happens in the body from HS may be part of the increased likelihood of squamous cell skin cancer, he adds.

Another unique factor of squamous cell carcinoma in HS is location. “HS primarily occurs in places where skin rubs on skin,” says Rita Pichardo, MD, a dermatologist at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina, who runs an HS clinic. “These regions can be chronically inflamed for many years. That makes certain regions in the body — the vulvar, perianal, and perineal areas — especially prone to developing skin cancer.”

A review of studies published in 2021 looked at SCC as a result of HS and found that the most common sites of the cancer were the buttocks, the perianal region, and the genitals.

For this reason, it’s especially important for people with HS to see a dermatologist every 6 to 12 months for a full-body cancer screening, says Dr. Pichardo. Even then, “It can be difficult, even for a doctor, to spot skin cancer just by looking at it,” notes Garza, “so we’ll perform a biopsy on anything we find that’s concerning.”

Self-exams between skin checks are also a good idea. About once a month, examine your skin, using a mirror for areas you can’t see otherwise, to look for anything that seems different or unusual, advises Garza. “Trust your intuition,” he adds. “If something looks weird or you’ve never noticed it before, bring it to the attention of your doctor.”

Some specific symptoms to look for: “A place on your skin that bleeds by itself is a red flag,” says Garza. It’s not uncommon for people who have HS to notice pus or even blood coming out of their skin, but since bleeding can be a nonspecific sign of skin cancer, it needs to be checked out by your dermatologist.

Additionally, within an area of HS lesions that are improving with treatment, if there’s one that won’t go away or looks unusual, talk to your doctor, says Garza.

There are several simple ways to keep the already small risk of skin cancer associated with HS to an absolute minimum.

Follow your management plan to a T. “There are no studies that show with certainty whether or not managing HS well can reduce associated skin cancer risk, but it’s probably the case,” says Garza.

• People living with hidradenitis suppurativa face a higher risk of skin cancer, particularly squamous cell carcinoma, than the rest of the population.
• Though this elevated risk is small, experts advise early diagnosis and treatment, followed by regular skin cancer screenings every 6 to 12 months.
• While the reasons for increased rates of skin cancer in HS are not fully understood, research shows that inflammation and immunosuppressive treatments may be associated.
• Proactive measures, such as getting diagnosed early and using layered sun protection, can reduce cancer-related risks in people who have hidradenitis suppurativa.