INTRODUCTION
Non-melanoma skin cancers, comprising primarily of cutaneous basal (BCC) and squamous cell carcinomas (SCC), present a significantly higher mortality and morbidity risk in patients with skin of color as compared with their age-matched peers.1,2 This disparity is partly attributable to later stages of diagnosis and pervasive cultural misconceptions about skin cancer risks in skin of color.3 This may also be due to varied prevalence of subtypes amongst different populations, each with their discrete natural histories. For example, while sun-induced squamous cell carcinomas common in Caucasian populations typically carry a 1 to 4% risk of metastasis, squamous cell carcinoma arising in chronic scarring processes — more prevalent in African American patients — demonstrate a markedly higher metastasis risk of 20 to 40%.2
Given these alarming gaps, it is crucial to thoroughly explore accessible prophylactic and treatment options for non-melanoma skin cancer. Within this context, metformin, a commonly used diabetes medication, emerges as a potentially significant addition to the treatment ladder for skin cancer. Preliminary findings in Iceland suggest metformin’s protective role against squamous cell carcinoma but not basal cell carcinoma.4 Similar conclusions have been drawn from population-level studies in Taiwan and the United States, which reported a reduced risk of non-melanoma skin cancer associated with metformin use; however, they did not differentiate between SCC and BCC in their analyses.5,6
Despite these promising leads, there remains a significant gap in our understanding of the impact of metformin on squamous cell carcinoma and basal cell carcinoma risk, especially as it relates to patients with skin of color. Our study utilizes the All of Us research database, which captures other patients who have historically been underrepresented in biomedical research, to shed light on the potential benefits of metformin in the context of non-melanoma skin cancers while capturing these specific populations.
Given these alarming gaps, it is crucial to thoroughly explore accessible prophylactic and treatment options for non-melanoma skin cancer. Within this context, metformin, a commonly used diabetes medication, emerges as a potentially significant addition to the treatment ladder for skin cancer. Preliminary findings in Iceland suggest metformin’s protective role against squamous cell carcinoma but not basal cell carcinoma.4 Similar conclusions have been drawn from population-level studies in Taiwan and the United States, which reported a reduced risk of non-melanoma skin cancer associated with metformin use; however, they did not differentiate between SCC and BCC in their analyses.5,6
Despite these promising leads, there remains a significant gap in our understanding of the impact of metformin on squamous cell carcinoma and basal cell carcinoma risk, especially as it relates to patients with skin of color. Our study utilizes the All of Us research database, which captures other patients who have historically been underrepresented in biomedical research, to shed light on the potential benefits of metformin in the context of non-melanoma skin cancers while capturing these specific populations.
