Do TNF inhibitors increase the risk of skin cancer in axial spondyloarthritis?
If you have axial spondyloarthritis (axSpA) and are taking or considering a TNF inhibitor, you may wonder about skin cancer risk. Research shows that TNF inhibitors are associated with a higher chance of non-melanoma skin cancer (NMSC), such as basal cell or squamous cell carcinoma. However, the overall risk of other cancers does not appear to be significantly increased. This answer explains what the evidence says and what you can discuss with your doctor.
What the research says
A 2026 narrative review of biologic and targeted synthetic DMARDs in inflammatory arthritides, including axSpA, found that non-melanoma skin cancer is the most consistent treatment-related cancer signal, especially with TNF inhibitors 3. The review notes that other biologic classes, like IL-17 inhibitors, appear neutral or reassuring for cancer risk 3.
A meta-analysis of JAK inhibitors across several diseases, including axSpA, compared cancer rates between JAK inhibitors and TNF inhibitors. It found no significant difference in overall malignancy risk between the two drug classes, but the analysis did not specifically report NMSC rates for TNF inhibitors alone 7.
Another meta-analysis in patients with inflammatory arthritis (including axSpA) who had a prior cancer found that TNF inhibitors did not significantly increase the risk of new or recurrent cancer overall (rate ratio 1.11, 95% CI 0.85-1.46). However, the risk of recurrent skin cancer was elevated (rate ratio 1.32, 95% CI 1.02-1.72) 8. This suggests that people with a history of skin cancer may need extra caution.
Overall, the evidence points to a small but real increase in non-melanoma skin cancer with TNF inhibitors, while other cancers are not clearly increased. Regular skin checks are a reasonable precaution.
What to ask your doctor
- Given my personal risk factors (age, sun exposure, smoking, family history), what is my chance of developing skin cancer on a TNF inhibitor?
- Should I have regular skin exams by a dermatologist while on this treatment?
- If I have had skin cancer before, is a TNF inhibitor still safe for me, or would another biologic be better?
- What symptoms of skin cancer should I watch for, and how often should I check my skin?
- Are there any other medications for axial spondyloarthritis that might have a lower skin cancer risk?
This question is drawn from common patient questions about Rheumatology and answered using cited medical research. We do not provide individualized advice.