title: Facial resurfacing for nonmelanoma skin cancer prophylaxis.
abstract: OBJECTIVE
  To determine the effect of facial skin resurfacing for treatment of actinic keratoses (AKs) and prophylaxis against new primary basal and squamous cell carcinomas in individuals with previous nonmelanoma skin cancer (NMSC) or severe photodamage.
  
  
  METHODS
  Randomized, prospective 5-year trial.
  
  
  METHODS
  Dermatology and otolaryngology clinics of a Veterans Affairs hospital.
  
  
  METHODS
  Thirty-four patients with a history of facial or scalp AKs or basal or squamous cell carcinoma were enrolled. Five of 7 eligible patients who declined study-related treatment were used as controls. Twenty-seven patients were randomized to 3 treatment arms; 3 patients were discontinued from the study.
  
  
  METHODS
  Carbon dioxide laser resurfacing, 30% trichloroacetic acid peel, or 5% fluorouracil cream applied twice daily for 3 weeks.
  
  
  METHODS
  Reduction in the number of AKs was measured 3 months after treatment. The incidence of new NMSC in treated areas was assessed between January 1, 2001, and June 30, 2005. Times from baseline to diagnosis of first skin cancer were compared between the treatment and control groups.
  
  
  RESULTS
  Treatment with fluorouracil, trichloroacetic acid, or carbon dioxide laser resulted in an 83% to 92% reduction in AKs (P< or =.03), a lower incidence of NMSC compared with the control group (P<.001), and a trend toward longer time to development of new skin cancer compared with the control group (P=.07). However, no significant differences were noted among the treatment groups.
  
  
  CONCLUSIONS
  All 3 modalities demonstrated benefit for AK reduction and skin cancer prophylaxis compared with controls and warrant further study in a larger trial.
authors.affiliation: Department of Dermatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Basil M
authors.initials: BM
authors.lastname: Hantash
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Stewart
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Cooper
authors.forename: Wingfield E
authors.initials: WE
authors.lastname: Rehmus
authors.forename: R James
authors.initials: RJ
authors.lastname: Koch
authors.forename: Susan M
authors.initials: SM
authors.lastname: Swetter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000517:prevention & control; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000517:prevention & control; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005145:Face; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage*; D007642:Keratosis / Q000473:pathology / Q000517:prevention & control*; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012535:Scalp; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000473:pathology / Q000517:prevention & control*; D016896:Treatment Outcome; D014238:Trichloroacetic Acid / Q000008:administration & dosage
chemical_list: D007641:Keratolytic Agents; D002245:Carbon Dioxide; D014238:Trichloroacetic Acid; D005472:Fluorouracil