Review Findings Suggest Melanoma and Hidradenitis Suppurativa Are Risk Factors for Completed Suicide

A recent review and meta-analysis reported that both melanoma and hidradenitis suppurativa (HS) are risk factors for completed suicide.¹

Published in the Journal of the European Academy of Dermatology and Venereology, the review also found that female patients with non melanoma skin cancer (NMSC) demonstrated an increased risk of completed suicide when compared to a control group.

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Background and Methods

While numerous studies have explored the psychological burden of skin diseases,² much of the existing research focuses on suicidality,³ which includes suicidal ideation and attempts rather than completed suicide. Given this gap, researchers conducted a systematic review and meta-analysis to clarify the relationship between specific dermatologic conditions and the risk of completed suicide.

The study systematically reviewed data from PubMed, Embase, and PsycINFO, covering studies from their inception until June 2023. Eligible studies included at least 10 adult patients and specifically examined completed suicide in individuals with dermatologic conditions. A total of 37 studies met the inclusion criteria, representing over 3.8 million patients with skin disease and more than 33 million controls.

Investigators utilized a random-effects model to account for variability between studies, and the Newcastle-Ottawa Scale assessed study quality. Meta-analyses were conducted separately for 13 identified skin diseases, including psoriasis, dermatitis, melanoma, non-melanoma skin cancer, and HS, to determine their association with completed suicide.

Findings

In total, 14 studies investigated psoriasis and completed suicide, including 3 case-control and multiple cohort studies. The meta-analysis pooled data from 6 studies and found no increased risk of suicide in patients with psoriasis (OR: 1.42; 95% CI: 0.76–2.68). Further analysis of psoriasis severity also showed no significant association with suicide risk.

Eight studies assessed atopic dermatitis (AD), eczema, and contact dermatitis in relation to suicide. Five studies contributed to the meta-analysis, which found no increased suicide risk for patients with AD (OR: 1.54; 95% CI: 0.57–4.17). One study suggested a potential seasonal variation in suicides among patients with atopic conditions.

Five studies examined HS and suicide, with 2 providing sufficient data for meta-analysis. Results indicated a significant increase in completed suicide risk among patients with HS compared to the general population (OR: 2.86; 95% CI: 1.56–5.24). Additional studies supported this finding, showing elevated suicide rates when combining psychiatric disease and suicide-related mortality.

A total of 12 studies explored the link between skin cancers and suicide, with mixed findings. Four studies included in the meta-analysis found a higher suicide risk among patients with melanoma (SMR: 2.89; 95% CI: 1.97–3.81). The first year post-diagnosis was identified as a particularly vulnerable period. Two cohort studies found an elevated suicide risk among women with NMSC, but stratification by gender yielded inconclusive results for men. A single study assessing conditions such as Merkel cell carcinoma and dermatofibrosarcoma found no significant association with suicide.

Limited data were available for other dermatologic diseases. One study of prurigo nodularis reported no increased suicide risk. Acne was linked to a possible increased suicide risk in women, though statistical significance was not established. Alopecia areata was associated with suicide and self-inflicted injury in one inpatient study.

Conclusions

The study has limitation, including inconsistencies in inclusion criteria, data sources, and diagnostic definitions, which contributed to selection bias and variability in findings. Differences in health care systems, access to treatments, and coding methods further affected the results, with most data coming from economically developed regions.

However, the meta-analysis highlights the heightened suicide risk among patients with HS and melanoma, particularly within the first year after melanoma diagnosis. While psoriasis and AD showed no increased risk, further research is warranted to clarify associations in other dermatologic conditions, according to study authors Hrvatin et al.

"Suicidality should be considered by physicians when treating dermatological disease, especially when treating patients with hidradenitis suppurativa and melanoma," review authors wrote.

References

1. Hrvatin Stancic B, Henning MAS, Eriksen N, Emilie Dornonville de la Cour J, Saunte DML, Jemec GBE. Completed suicide in patients with skin disease: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. Published online March 17, 2025. doi:10.1111/jdv.20609
2. Connor CJ. Management of the psychological comorbidities of dermatological conditions: practitioners' guidelines. Clin Cosmet Investig Dermatol. 2017;10:117-132. Published 2017 Apr 20. doi:10.2147/CCID.S111041
3. Pronizius E, Voracek M. Dermatologists' perceptions of suicidality in dermatological practice: a survey of prevalence estimates and attitudes in Austria. BMC Dermatol. 2020;20(1):10. Published 2020 Sep 29. doi:10.1186/s12895-020-00107-w