Skin cancer risk in alopecia areata: a systematic review and meta-analysis

Introduction Skin cancers are the most common malignancy worldwide, and identifying populations with altered risk is essential for informing prevention and surveillance strategies. Emerging evidence suggests that alopecia areata (AA) may be associated with reduced skin cancer risk, potentially reflecting enhanced cytotoxic immune activity. Methods We conducted a systematic review and meta-analysis to evaluate the incidence of skin cancers in patients with AA. PubMed, Embase, Scopus, and ClinicalTrials.gov were searched through July 2025. Of 1, 039 records identified, eight studies met inclusion criteria, with six included in the quantitative synthesis. Results AA was associated with a statistically significant reduction in melanoma incidence (OR 0.58; 95% CI, 0.36-0.94; p = 0.028). Overall skin cancer risk was reduced but not statistically significant (OR 0.58, 95% CI, 0.27-1.22). Pooled estimates for basal cell carcinoma (OR 0.43; 95% CI, 0.11-1.75) and squamous cell carcinoma (OR 0.66; 95% CI, 0.28-1.57) suggested directionally reduced associations, but did not reach statistical significance. Between-study heterogeneity was high (I 2 80% for BCC and SCC), however sensitivity analyses, including leave-one-out tests, confirmed the stability of the protective trend. Discussion These findings suggest that AA is not associated with increased skin cancer risk and demonstrates an inverse association with melanoma incidence, although substantial heterogeneity and sensitivity analyses warrant cautious interpretation. These results provide important baseline context for patient counseling and for interpreting longterm safety data as systemic therapies, including JAK inhibitors, are increasingly used. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251123793.