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Competing Interests: Conflicts of interest Dr Ruiz serves is a consultant for Regeneron, Checkpoint Therapeutic, Feldan Pharmaceuticals. She serves as a Principal Investigator/Co-Investigator for the following companies: Regeneron (PI/Co-I), Merck (Co-I), Castle Biosciences (Co-I) and is the Executive Officer of Skin Cancer Outcomes Consortium (SCOUT) Skin Cancer Champions. Dr Carr is an investigator for Regeneron (no direct funds). Dr Cañueto has the following disclosures: grants to institution: Sanofi/Regeneron, Castle Biosciences; Lectures honoraria: Sanofi, Almirall, AbbVie, Regeneron, Sun Pharma; Payment for expert testimony: Sanofi, Regeneron, Almirall; Support for attending meetings: Pfizer, Almirall, Lilly, Castle Biosciences; Advisory board: Almirall, Sanofi, Regeneron, Kyowa, Roche, InflaRx; Funding: support by the Gerencia Regional de Salud de Castilla y León (GRS2549/A/22) and by the Instituto de Salud Carlos III (PI21/01207), co-financed by European Union. Dr Mangold has patent Methods and Materials for assessing and treating cutaneous squamous cell carcinoma (provisional 63-423254) and Regeneron Consulting with payments to the institution. He has consulted for Kyowa, Eli Lilly, Momenta, UCB, and Regeneron in the past, greater than 24 months ago. He has consulted for PHELEC in the past, great than 12 months. He has consulted for Incyte, Soligenix, Clarivate, and Bristol Myers Squibb in the past, less than 12 months ago. He consults for Nuvig, Argenyx, Boehringer, Janssen, and Ingelheim currently. He consults for Pfizer currently with payments to the institution. He has grant support from Kyowa, Miragen, Regeneron, Corbus, Pfizer, Incyte, Eli Lilly, Aregenx, Palbella, AbbVie, Priovant, Merck in the last 24 months. Beyond 24 months, grant support has come from Sun Pharma, Elorac, Novartis, and Janssen. His current patents include the use of oral JAKi in Lichen Planus (provisional 63/453,065), and Topical Ruxolitinib in Lichen Planus (WO2022072814A1). Dr Carucci receives funding for investigator initiated basic science research from Regeneron and is a PI for a clinical trial sponsored by Regeneron. Dr Koyfman has the following disclosures: Advisory board (paid): Merck, BMS, Regeneron, Galera therapeutics; Advisory board (unpaid): Castle Biosciences; Research support: Castle biosciences, merck, BMS, Regeneron; Honoraria: UpToDate. Dr Vidimos has the following dicslosures: Research Support – Castle; Advisory Board - Inhibitor Therapeutics; Honoraria - Up to Date. Dr Wysong has received an institutional research grant from Castle Biosciences. Drs Granger, Ran, Groover, Shahwan, Hirotsu, Carter, Girardi, Brodland, Sruvastava, Zitelli, and Willenbrink have no conflicts of interest to declare.

Background: Immunosuppression is a known risk factor for the development of cutaneous squamous cell carcinoma (CSCC), especially in solid organ transplant recipients and chronic lymphocytic leukemia. However, this risk is less well defined in autoimmune and inflammatory conditions., Objective: Assess the impact that disease-type, duration of immunosuppression, and systemic medications have on CSCC accrual rates, defined as the number of CSCCs a patient develops per year, in autoimmune and inflammatory conditions., Methods: Retrospective review of 94 immunosuppressed (rheumatoid arthritis: 31[33.0%], inflammatory bowel disease: 17[18.1%], psoriasis: 11[11.7%], autoimmune other (AO): 24[25.5%], inflammatory other: 21[22.3%]) and 188 immunocompetent controls to identify all primary, invasive CSCCs diagnosed from 2010 to 2020., Results: Immunosuppressed patients had higher CSCC accrual rates than immunocompetent controls (0.44 ± 0.36): total cohort (0.82 ± 0.95, P < .01), rheumatoid arthritis (0.88 ± 1.10, P < .01), inflammatory bowel disease (0.94 ± 0.88, P < .01), psoriasis (1.06 ± 1.58, P < .01), AO (0.72 ± 0.56, P < .01), and inflammatory other (0.72 ± 0.61, P < .01). There was an association between increased tumor accrual rates and exposure to systemic medications including, immunomodulators, tumor necrosis factor-alpha inhibitors, non-tumor necrosis factor inhibitor biologics, and corticosteroids, but not with number of systemic medication class exposures or duration of immunosuppression., Limitations: Retrospective, singlecenter study., Conclusion: Patients with autoimmune and inflammatory conditions accrue CSCCs at higher rates than immunocompetent patients., Competing Interests: Conflicts of interest Dr Emily Ruiz has served as a consultant for Regeneron, Genentech, and Checkpoint Therapeutics. Dr Chrysalyne Schmults serves as a consultant for the following companies: Regeneron and Sanofi, and Castle Biosciences. She has research support from Castle Biosciences, and Merck and Regeneron. She serves on the Board of Directors for American Society of Dermatologic Surgery as well as Secretary/Treasurer of the International Society of Dermatologic Surgery. She is also the Non-Melanoma Skin Cancer Panel Chair for the National Comprehensive Cancer Network. She currently serves as the Founder/ President of Skin Cancer Outcomes (SCOUT). Emily Granger, BS has no relevant conflicts of interest. Morgan Groover, BS has no relevant conflicts of interest. Emily Karn, MS has no relevant conflicts of interest. Dr Fadi Murad has no relevant conflicts of interest. Dr Catherine Harwood MA PhD FRCP has no relevant conflicts of interest. Dr Charlotte M. Proby MA MRCP has no relevant conflicts of interest., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.