If you’re among the up to 4 percent of people worldwide living with hidradenitis suppurativa (HS), you know how challenging it can be to manage the painful bumps and flare-ups. But did you know that HS can affect your long-term health in other ways? Research has shown that people with HS may have a higher risk of certain types of cancer, including skin cancers. Although managing the physical symptoms of HS can be difficult, being aware of its potential health impacts can encourage you to be more proactive about your health and well-being.

Hidradenitis Suppurativa and Skin Cancer

Many diseases can occur alongside HS, including cancer. Over the past 20 years, researchers have found links between HS and nonmelanoma skin cancers, including squamous cell carcinoma (SCC), the second most common type of skin cancer. HS can also lead to basal cell carcinoma (BCC), the most common type of skin cancer.

SCC is a rare complication of HS, but it can spread throughout the body and be life-threatening if left untreated. Some studies have reported cases of individuals developing SCC from HS lesions. According to The British Journal of Dermatology, SCC with HS occurs more commonly in men than in women.

Usually, SCC occurs in HS lesions on the buttocks, groin, and perineum (the tiny patch of sensitive skin between the genitals). This type of skin cancer usually develops in people who have had HS for many years and haven’t been able to manage their symptoms well.

Tumor Necrosis Factor-Alpha Inhibitors and Squamous Cell Carcinoma

Tumor necrosis factor-alpha (TNF-alpha) is a protein in the body that contributes to inflammation. Biologic drugs called TNF-alpha inhibitors treat inflammatory diseases, including HS, inflammatory bowel disease, and inflammatory arthritis.

TNF-alpha inhibitors can help manage HS symptoms, but they come with some risks. Research suggests that these medications could increase the risk of certain types of cancer, including nonmelanoma skin cancers such as SCC.

The U.S. Food and Drug Administration has approved one TNF-alpha inhibitor, adalimumab (Humira), for treating moderate to severe HS. Other TNF-alpha inhibitors that might be prescribed off-label (not for the FDA-approved use) include:

• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel)
• Golimumab (Simponi)
• Infliximab (Remicade)

Some studies didn’t find a link between these drugs and increased cancer risk, but the researchers didn’t focus on people with HS. However, case reports have documented instances in which people with HS treated with TNF-alpha inhibitors developed SCC. According to MDedge Dermatology, these cases involved men with a history of HS lasting 20 years or more.

Recent research has highlighted a potential link between nonmelanoma skin cancers and the use of TNF-alpha inhibitors to treat skin conditions, including HS and psoriasis. It’s important to weigh the benefits and risks of these medications with your health care provider to make the best decision for your long-term health.

Treatment Options for Squamous Cell Carcinoma

The main treatment for squamous cell carcinoma is surgery. When detected early, SCC can be treated with minor excisions, similar to skin biopsies (taking a small piece of tissue to be examined in a lab), or with cryotherapy, a treatment that uses extreme cold to destroy abnormal tissue.

More advanced SCC may require more extensive surgery. If the cancer has grown significantly or metastasized (spread to other parts of the body), additional treatments such as radiation and targeted therapy may be needed.

Finding cancer early is key to successful treatment. If you notice new or changing skin growths, see your dermatologist or health care provider for prompt evaluation.

Hidradenitis Suppurativa and Other Types of Cancer

HS has been linked to an increased risk of other types of cancers besides SCC. A 2020 study found that people with HS had an increased overall risk of cancer and specific types like lymphoma (a blood cancer) and cancers of the mouth and throat, central nervous system, liver, prostate, and colon.

It's important to discuss any concerns with your health care provider so that you can understand your risks and stay informed about your health.

How Can Hidradenitis Suppurativa Lead to Cancer?

Researchers don’t fully understand how HS increases cancer risk. Some believe that it’s due to chronic inflammation, a known risk factor for cancer. Although acute (sudden, short-term) inflammation heals injuries, chronic (lifelong) inflammation, like that involved in HS, can occur without an obvious trigger.

Persistent inflammation can cause ongoing damage to healthy tissue. Over time, repeated cycles of inflammation and healing may lead to cellular changes that increase the risk of cancer.

What Are the Signs and Symptoms of Cancer?

It’s crucial to know the symptoms of cancer, especially if you’re at higher risk of cancer. It’s also important to note that although HS can increase your statistical odds, the risk of developing most types of cancer is still low.

Having other autoimmune or autoinflammatory diseases in addition to HS can raise your cancer risk. If you’ve had cancer in the past or have a family history of certain types, you may face a higher risk. Understanding these risk factors can help you stay proactive about your health.

General Cancer Symptoms

Many types of cancer share similar symptoms. Some general symptoms to watch out for include:

• Weight loss or gain (10 pounds or more) for no apparent reason
• Unexplained or new pain
• New lumps, masses, or tumors
• New or changing skin lesions
• Fatigue (tiredness not improved by rest)
• Fever
• Night sweats
• Headaches
• Changes in bowel habits, including blood in your stool
• Pain or bleeding when urinating
• Loss of appetite
• Difficulty swallowing
• Nausea or vomiting
• A new, persistent cough
• Vision or hearing changes
• Unusual bleeding or unexplained bruising

These symptoms aren’t specific to cancer and also can be caused by other conditions. If you develop any unexplained changes in your body or health, it’s important to talk with your health care provider.

Nonmelanoma Skin Cancer Symptoms

Squamous cell carcinoma and basal cell carcinoma have many similar symptoms, including:

• New or changing skin growths or lesions
• Skin ulcers or lesions with a raised border and a crusty or bloody, indented center
• Smooth, shiny, wartlike, or crusted bumps or nodules
• Discolored, sometimes scaly patches of skin
• Scarlike lesions without a previous injury
• Open sores that don’t heal
• Skin lesions that bleed

If you have any of these symptoms, see a doctor, especially if they occur on or near HS lesions.

What Can You Do To Reduce Your Cancer Risk?

You can take some steps to reduce your risk of developing skin cancer and other cancers linked with HS. Some key ways to lower your risk of SCC with HS include the following:

• Get appropriate treatment for your HS.
• Stop smoking cigarettes.
• Achieve or maintain a healthy weight.
• Attend regular checkups.

Overall cancer prevention tips include:

• Avoid tobacco smoke.
• Eat a balanced diet with more vegetables and fewer processed foods.
• Stay active.
• Use sunscreen and cover exposed skin when outdoors.
• Get vaccinated for hepatitis B and HPV.
• Avoid risky behaviors by practicing safe sex and not sharing needles.

Can Cancer Be Misdiagnosed as Hidradenitis Suppurativa?

Cancers like squamous cell carcinoma can sometimes be mistaken for HS due to similar symptoms, such as lumps or sores. Furthermore, HS can affect the breasts. It can be difficult to tell the difference between symptoms of HS and some types of breast cancer, since both can cause lumps or changes in the skin on the breast.

There’s no clear link between HS and breast cancer, but since the symptoms can look similar, diagnosis may be tricky. If you notice any changes in your breast, it’s important to see your health care provider. They may need to do a biopsy (take a bit of tissue to be examined in a lab) to confirm that your symptoms aren’t caused by cancer.

Does Hidradenitis Suppurativa Affect Life Expectancy?

HS isn’t fatal on its own, and it doesn’t usually shorten life expectancy. However, the symptoms can have a big impact on your quality of life. It’s important to work with your health care provider to manage HS to reduce complications and improve your well-being.

Living with hidradenitis suppurativa can be challenging, even without the added concerns about cancer risk. It’s important to stay informed and proactive, but try not to let the possibility of cancer overshadow your everyday life.

Being aware of the signs and symptoms of skin cancer is important, and managing your HS symptoms effectively is just as crucial. If you feel you aren’t getting the care you need, reach out to a health care professional experienced in treating HS.

Talk With Others Who Understand

On myHSTeam, the social network for people with hidradenitis suppurativa and their loved ones, more than 44,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Are you living with HS? Have you talked about your skin cancer risk with your health care team? Share your experience in the comments below, or start a conversation by posting on your Activities page.