title: Chemoprevention of nonmelanoma skin cancer with systemic retinoids: practical dosing and management of adverse effects.
abstract: BACKGROUND
  In patients with nonmelanoma skin cancer that is high risk or characterized by numerous tumors, chemoprevention with systemic retinoids may effectively decrease the number of new tumors whereas the chemosuppressive effects may reduce the risk of recurrence or disease progression. A patient's intolerance of the mucocutaneous effects of retinoid therapy or abnormal laboratory findings may hamper continuous therapy.
  
  
  OBJECTIVE
  To present a method for optimizing tolerance of systemic retinoids for chemoprevention and for monitoring and managing adverse events.
  
  
  METHODS
  After reviewing the data on the use of systemic retinoids for chemoprevention, we developed a simplified approach for administering oral retinoids for chemoprevention of nonmelanoma skin cancer as well as basic guidelines for the prevention and management of adverse effects and appropriate laboratory monitoring.
  
  
  RESULTS
  Chemoprevention with systemic retinoids in patients with a history of numerous tumors or high-risk skin cancer can be optimized with graduated dose escalation and preventive strategies for the most common adverse effects. Routine laboratory monitoring may assist in detecting adverse effects, which can be managed in most cases.
  
  
  CONCLUSIONS
  In our experience, the effective use of systemic retinoids for chemoprevention of nonmelanoma skin cancer in high-risk patients can be optimized through a standardized, proactive approach.
authors: Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors: Clark C
authors: CC
authors: Otley
authors: Thomas
authors: T
authors: Stasko
authors: Whitney D
authors: WD
authors: Tope
authors: Mark
authors: M
authors: Lebwohl