Would you avoid the use of a TNF inhibitors in patients with a remote history of melanoma, including those with ocular melanoma?

Clinical trials of TNF inhibitors have identified a small but increased risk of malignancy with the use of TNF inhibitors, and most, but not all, of the follow-up studies done with real-world registries have confirmed this. These registries are of course sometimes affected by the behavior of physicians, in that, if a doctor feels the patient is at increased risk for malignancy, they would not start the patient on a TNF inhibitor, so slowly selecting for patients who have a lower than usual risk for malignancy. This may mean that the real risk is actually higher than what is reported in real-world registries.

Melanoma has been reported to be increased in some studies of TNF inhibitors, and a history of melanoma, in my opinion, places the pat...