Azathioprine and Skin Cancer — SCE Rheumatology MCQ
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Correct answer: E — Review azathioprine and overall immunosuppression, individualising any reduction or switch according to relapse risk
Explanation lettering: E = shown as B · D = shown as C · C = shown as D · B = shown as E
Azathioprine increases the risk of non-melanoma skin cancer, including squamous cell carcinoma, and interacts synergistically with long-wave ultraviolet radiation. Following an SCC, the regimen should therefore be reviewed with dermatology and the vasculitis team, balancing secondary cancer prevention against the potentially serious consequences of AAV relapse. Any dose reduction, withdrawal or substitution should be individualised, with immunosuppression kept at the lowest effective level. Continuing or automatically restarting the same dose without reassessment (A or D) ignores the treatment-associated risk. Permanent cessation of all immunosuppression (C) is not justified after a first localised SCC and may precipitate relapse. Increasing azathioprine (E) would increase exposure. Mycophenolate is not an automatic replacement; current BSR guidance reserves it for selected patients when preferred maintenance options are unsuitable.
Reference: Electronic Medicines Compendium. Azathioprine tablets 50 mg, Summary of Product Characteristics, sections 4.4 and 4.8, 2026. https://www.medicines.org.uk/emc/product/14296/smpc