Prevention of Skin Cancer During Acitretin Therapy in Renal-Transplant Recipients; a Placebo-Controlled Study

Abstract

Forty-four renal-transplant recipients were enrolled in a randomised, doubleblind, placebo-controlled trial to test the possible skin-cancer-preventing effect of a six-month treatment with acitretin 30 mg daily. No deterioration in renal function occurred in any of the 38 evaluable patients treated. During the six-month treatment period 2 out of 19 patients (11%) in the acitretin group reported all together 2 new squamous cell carcinomas compared with 9 out of 19 patients (47%) in the placebo group who developed all together 18 new carcinomas: 15 squamous cell carcinomas, 1 Bowen’s disease and 2 basal cell carcinomas (chi-square 6.27, p = 0.01). Interestingly, the effect of acitretin in preventing new skin cancers could largely be attributed to the group of 19 patients with a history of skin cancer. Most patients treated with acitretin had mild mucocutaneous side effects, but these were well manageable. Some patients experienced mild hair loss. With the exception of three patients no increase in serum cholesterol or triglyceride above pre-treatment levels was observed, and liver function remained unchanged in all patients. Acitretin 30 mg daily during six months had significantly more effect than placebo to prevent squamous cell carcinomas in a group of renal-transplant recipients who suffered severely from these lesions. This effect was most pronounced in patients with a history of skin cancer.