Review Findings Question the Assumed Skin Cancer Risks in Alopecia Areata

People living with alopecia areata (AA) may not face a heightened risk of skin cancer despite reduced scalp hair coverage, according to a new systematic review and meta-analysis that found a significantly lower incidence of melanoma among this patient population.

The analysis, published in Frontiers in Oncology, evaluated data from more than 860,000 patients across 8 retrospective studies conducted in the US, Sweden, Denmark, Taiwan, and the Republic of Korea. Researchers reported that AA was associated with a statistically significant reduction in melanoma incidence, whereas rates of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and overall skin cancer also trended lower but did not consistently reach statistical significance.

The findings arrive as clinicians increasingly prescribe Janus kinase (JAK) inhibitors for moderate to severe AA, raising questions about long-term malignancy risks and the need for baseline disease-specific cancer data.

“AA is not associated with increased skin cancer risk and rather establishes an inverse association with melanoma incidence,” the authors wrote. They added that the results “provide essential context for patient counseling and for interpreting long-term safety data as systemic therapies, including JAK inhibitors, become increasingly integrated into AA management.”

AA is a chronic autoimmune condition characterized by nonscarring hair loss and perifollicular T-cell infiltration. The condition affects approximately 2% of individuals during their lifetime. Because the scalp is frequently exposed to ultraviolet radiation when hair loss occurs, researchers noted that clinicians have questioned whether patients with AA could face increased skin cancer susceptibility. Prior studies, however, produced conflicting findings, with some reporting lower cancer rates and others showing neutral or slightly elevated risks.

Alopecia Data Collection and Skin Cancer Literature Review

To clarify the association, investigators searched PubMed, Embase, Scopus, and ClinicalTrials.gov through July 2025 for observational studies comparing skin cancer incidence among patients with AA and controls. Of 1039 identified records, 8 studies met inclusion criteria, and 6 were included in the pooled quantitative analysis.

The studies ranged from cohorts of slightly more than 500 patients to a Korean registry analysis including more than 650,000 patients with AA. Across studies, the average patient age was approximately 40 years, and 51.4% of participants were women. Several cohorts included patients with alopecia totalis or alopecia universalis in addition to patchy AA.

In the pooled melanoma analysis, investigators found that patients with AA had 42% lower odds of melanoma compared with controls (OR, 0.58; 95% CI, 0.36-0.94; P = .028). The melanoma findings showed moderate heterogeneity across studies (I² = 58%).

Results for nonmelanoma skin cancers followed a similar directional trend but lacked statistical significance. For BCC, pooled analysis showed an OR of 0.43 (95% CI, 0.11-1.75), whereas SCC demonstrated an OR of 0.66 (95% CI, 0.28-1.57). Overall skin cancer risk among patients with AA was reduced but not statistically significant (OR, 0.58; 95% CI, 0.27-1.22).

Several individual studies demonstrated pronounced reductions in skin cancer incidence. One US retrospective cohort study reported markedly lower rates of melanoma, BCC, and SCC among patients with AA, alopecia totalis, and alopecia universalis compared with controls. Swedish registry data similarly showed lower hazards for invasive melanoma and SCC among patients with AA.

Researchers also noted that despite concerns surrounding scalp sun exposure, the included studies did not identify a disproportionate increase in scalp-specific malignancies among patients with AA. In fact, some studies found fewer melanomas localized to the scalp among individuals with AA compared with controls.

The authors suggested that the autoimmune mechanisms underlying AA may partially explain the observed association. They highlighted the role of cytotoxic CD8-positive T cells, interferon-γ signaling, and IL-15 pathways, all of which are involved in tumor immunosurveillance and melanoma immune responses.

“Collectively, these observations suggest that AA may serve as a human disease model characterized by sustained cytotoxic immune activation,” the researchers wrote, noting that these immune pathways “may intersect with pathways relevant to antitumor immunity.”

Still, investigators cautioned against drawing causal conclusions from the findings. All included studies were observational, and most were judged to carry a moderate risk of bias due to reliance on administrative coding, incomplete adjustment for confounding variables, or referral population bias. Researchers also acknowledged inconsistent reporting of UV exposure, skin phototype, treatment history, and geographic variation across studies.

The pooled analyses additionally demonstrated substantial heterogeneity, particularly for BCC and SCC outcomes, with I² values ranging from 84% to 95%. Sensitivity analyses showed that the melanoma association weakened when certain large registry studies were removed.

Why Researchers Questioned Possible Link Between AA and Melanoma

Concerns about skin cancer risk in people with alopecia have persisted for years because hair loss can leave the scalp more vulnerable to chronic ultraviolet exposure, while some forms of alopecia are also associated with long-standing inflammation and follicular damage. A previous peer-reviewed literature review on scarring alopecia noted that prolonged inflammation, immunologic changes, and increased sun exposure on unprotected scalp skin may contribute to the development of nonmelanoma skin cancers, helping explain why dermatologists have questioned whether patients with alopecia could face elevated malignancy risks.²

The authors of the present analysis emphasized that standard population-based skin cancer screening recommendations should still apply to patients with AA and that clinicians should continue individualized risk assessment based on ultraviolet exposure, family history, skin type, and prior immunosuppressive treatment use.¹

References
1. Gaumond SI, Abdshah A, Kamholtz I, et al. Skin cancer risk in alopecia areata: a systematic review and meta-analysis. Front Oncol. 2026;16:1787992. doi:10.3389/fonc.2026.1787992

2. Lee J, de Gregorio L, Tosti A. Scarring alopecia and risk of skin cancer: a literature review. Skin Appendage Disord. Published online March 20, 2025. doi:10.1159/000545345.