Facial resurfacing for nonmelanoma skin cancer prophylaxis.
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.
Hantash
Basil M
BM
Department of Dermatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
Stewart
Daniel B
DB
Cooper
Zachary A
ZA
Rehmus
Wingfield E
WE
Koch
R James
RJ
Swetter
Susan M
SM
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
D007641:Keratolytic Agents; D002245:Carbon Dioxide; D014238:Trichloroacetic Acid; D005472:Fluorouracil