Abstract
Some groups of people have a greater risk of developing common non-melanoma skin cancers (NMSC). To evaluate interventions for preventing NMSC in people at high risk of developing NMSC. We searched the Cochrane Skin Group Specialised Register (March 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007, MEDLINE (from 2003 to March 2007), EMBASE (from 2005 to March 2007), the metaRegister of Controlled Trials (February 2007). References from trials and reviews were also searched. Pharmaceutical companies were contacted for unpublished trials. Randomised controlled trials of adults and children at high risk of developing NMSC. Two review authors independently selected studies and assessed their methodological quality. We identified 10 trials (7,229 participants) that assessed a variety of interventions. One trial found T4N5 liposome lotion significantly reduced the rate of appearance of new BCCs in people with xeroderma pigmentosum. One of three trials of renal transplant recipients showed a significantly reduced risk of new NMSCs when acitretin was compared to placebo (relative risk (RR) 0.22 95% confidence interval (CI) 0.06 to 0.90) and no significant difference in risk of adverse events in two trials (RR 1.80, 95% CI 0.70 to 4.61). In three trials conducted in people with a history of NMSC, the evidence was inconclusive for the development of BCCs for retinol or isoretinoin. However the risk of a new SCC in one trial (HR 1.79, 95% CI 1.16 to 2.76) and adverse events in another trial (RR 1.76 95% CI 1.57 to 1.97) were significantly increased in the isotretinoin group compared with placebo. In one trial selenium showed a reduced risk of other types of cancer compared with placebo (RR 0.65, 95% CI 0.50 to 0.85) but also a significantly elevated risk of a new NMSC (HR 1.17 95% CI 1.02 to 1.34). The evidence for one trial of beta-carotene was inconclusive; and there was a trend towards fewer new NMSC in a trial of a reduced fat diet (RR 0.16, 95% CI 0.02 to 1.31), p=0.09. Some preventative treatments may benefit people at high risk of developing NMSC, but the ability to draw firm conclusions is limited by small numbers of trials, often with one trial per intervention or with inconsistent results between studies.
Highlights
Some groups of people have a greater risk of developing common non-melanoma skin cancers (NMSC)
People at increased risk of getting non-melanoma skin cancer include those with lowered immunity, a history of non-melanoma skin cancer, rare inherited genetic skin disorders, trauma to the skin, exposure to arsenic, albinism or having had psoralen and ultraviolet A treatment
For people with Xeroderma pigmentosum topical application of T4N5 liposome lotion is beneficial in reducing the rate of appearance of new basal cell carcinomas, it may increase the risk of a new squamous cell carcinoma
Summary
Some groups of people have a greater risk of developing common non-melanoma skin cancers (NMSC). Around 97% of skin cancers are epithelial in origin and are either basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs), collectively known as non-melanoma skin cancer (NMSC). BCC is defined as a slow-growing, locally invasive, malignant, epidermal skin tumour that mainly a ects people with light coloured skins (Telfer 1999). BCCs are the most common malignant growth found in humans and originate from basal cells of the epidermis (Lang 1991; Telfer 1999). Unlike BCC, which has no reported precursor lesions, there are two principal precursors of SCC: actinic (solar) keratoses (AKs) and Bowen's disease (intra-epidermal carcinoma; IEC), both of which are described as carcinoma-in-situ. SCC is distinguished from carcinoma-in-situ by having an invasive component (i.e. involving connective tissue and blood vessels in the dermis), which can be determined histologically (Goldman 1998)
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