Metformin is associated with decreased risk of basal cell carcinoma: A whole-population case-control study from Iceland

Jonas A. Adalsteinsson, Sonal Muzumdar, Reid Waldman, Rong Wu, Désirée Ratner, Hao Feng, Jonathan Ungar, Jonathan I. Silverberg, Gudridur H. Olafsdottir, Arni Kjalar Kristjansson, Laufey Tryggvadottir, Jon Gunnlaugur Jonasson

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Metformin has anticarcinogenic properties and is also known to inhibit the sonic hedgehog pathway, but population-based studies analyzing the potential protective effect for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are needed. Objectives: To delineate the association between metformin use and invasive SCC, SCC in situ (SCCis), and BCC. Methods: A population-based case-control study design was employed using all 6880 patients diagnosed in Iceland between 2003-2017 with first-time BCC, SCCis, or invasive SCC, and 69,620 population controls. Multivariate odds ratios (ORs) were calculated using conditional logistic regression. Results: Metformin was associated with a lower risk of developing BCC (OR, 0.71; 95% confidence interval [CI], 0.61-0.83), even at low doses. No increased risk of developing SCC was observed. SCCis risk was mildly elevated in the 501-1500 daily dose unit category (OR, 1.40; 95% CI, 1.00-1.96). Limitations: This study was retrospective in nature with the inability to adjust for ultraviolet exposure, Fitzpatrick skin type, and comorbidities. Conclusion: Metformin is associated with decreased risk of BCC development, even at low doses. Metformin might have potential as a chemoprotective agent for patients at high risk of BCC, although this will need confirmation in future studies.

Original languageEnglish
Pages (from-to)56-61
Number of pages6
JournalJournal of the American Academy of Dermatology
Issue number1
StatePublished - Jul 2021
Externally publishedYes


  • basal cell carcinoma
  • keratinocyte carcinoma
  • metformin
  • squamous cell carcinoma
  • squamous cell carcinoma in situ


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