Hydrochlorothiazide Is Associated with Modest Excess Risk for Melanoma

Information sourced from NEJM Journal Watch:

This drug previously has been linked to excess risk for nonmelanoma skin cancer.

Hydrochlorothiazide use is associated with excess risk for lip and nonmelanoma skin cancers, especially squamous cell cancers. Investigators in Denmark explored whether hydrochlorothiazide also is associated with risk for melanoma. They identified 19,000 adults with melanoma and compared them with 193,000 age- and sex-matched controls without cancer (except nonmelanoma skin cancer).

High use of hydrochlorothiazide (>50,000 mg total lifetime exposure or ≈6 years of use at standard doses) occurred in significantly more melanoma patients than controls (2.1% vs. 1.8%; odds ratio, 1.22). The researchers noted a nonsignificant trend toward a dose-dependent relation between lifetime hydrochlorothiazide use and diagnosis of melanoma and a significant association between hydrochlorothiazide use and two specific melanoma subtypes (nodular melanoma and lentigo melanoma). No association was found between melanoma and use of other antihypertensives.

COMMENT

These findings might be related to one of hydrochlorothiazide’s known side effects, photosensitivity, although the authors note that nodular melanoma is not clearly linked to sun exposure. Excess risk for melanoma is modest and probably would not be a major factor in deciding to use hydrochlorothiazide; however, clinicians should advise patients who use hydrochlorothiazide to minimize sun exposure.

Thomas L. Schwenk, MD reviewing Pottegård A et al. JAMA Intern Med 2018 May 29

CITATION(S):

Pottegård A et al. Association of hydrochlorothiazide use and risk of malignant melanoma. JAMA Intern Med 2018 May 29; [e-pub].

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