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Actinic keratoses†‡

Natural history and risk of malignant transformation in the Veterans Affairs Topical Tretinoin Chemoprevention Trial

  1. Vincent D. Criscione AB1,2,
  2. Martin A. Weinstock MD, PhD1,2,3,§,*,
  3. Mark F. Naylor MD4,
  4. Claudia Luque MD1,
  5. Melody J. Eide MD, MPH5,
  6. Stephen F. Bingham PhD6,
  7. for the Department of Veteran Affairs Topical Tretinoin Chemoprevention Trial Group

Article first published online: 20 APR 2009

DOI: 10.1002/cncr.24284

Issue

Cancer

Cancer

Volume 115, Issue 11, pages 2523–2530, 1 June 2009

Additional Information

How to Cite

Criscione, V. D., Weinstock, M. A., Naylor, M. F., Luque, C., Eide, M. J., Bingham, S. F. and for the Department of Veteran Affairs Topical Tretinoin Chemoprevention Trial Group (2009), Actinic keratoses. Cancer, 115: 2523–2530. doi: 10.1002/cncr.24284

Author Information

  1. 1

    Dermatoepidemiology Unit, Veterans Affairs Medical Center, Providence, Rhode Island

  2. 2

    Departments of Dermatology and Community Health, Brown University, Providence, Rhode Island

  3. 3

    Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island

  4. 4

    Department of Dermatology, Veterans Affairs Medical Center, Oklahoma City, Oklahoma

  5. 5

    Department of Dermatology, Henry Ford Hospital, Detroit, Michigan

  6. 6

    Veterans Affairs Cooperative Studies Coordinating Center, Perry Point, Maryland

  1. §

    Fax: (401) 457-3332

*Dermatoepidemiology Unit-111D, VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908-4799

  1. †

    Key personnel of the Department of Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) Trial include the following: Study Chairman's Office: Martin A. Weinstock (Chair) and Kimberly Marcolivio (Providence, RI). Executive Committee: Martin Weinstock (Providence, RI), Stephen Bingham (Perry Point, Md), John DiGiovanna (Providence, RI), Russell Hall (Durham, NC), Mark Naylor (Oklahoma City, Okla), J. Richard Taylor (Miami, Fla), Julia Vertrees (Albuquerque, NM), and Clifton White (Portland, Ore). Clinical Centers: Durham, NC (Russell Hall and Deborah Hannah); Chicago, Ill (Hines) (David Eilers, Tehming Liang, Nadia Sakla, and Ann Kreuger); Long Beach, Calif (Gary Cole, Edward Jeffes, and Terri Labrador); Miami, Fla (J. Richard Taylor, Robert Kirsner, Jonette E. Kerri, Anna G. Falabela, and Margarita Givens); Oklahoma City, Okla (Mark Naylor, Mary Beth Benson, and Lisa Perry); and Phoenix, Ariz (James Kalivas, Catherine Yanni, Selma Targovnik, Janet Austin, and Susan Collier). Cooperative Studies Program Coordinating Center (Perry Point, Md): Joseph F. Collins, Stephen Bingham, Beverly Calvert, Philip Connor, Colleen Crigler, Dawn Davis, Pat Grubb, Judy Kelly, Gail Kirk, Karen Lawson, Linda Linzy, Lorrine Palmer, and Maxine Rhoads. Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (Albuquerque, NM): Mike Sather, Erica Copeland, Carol Fye, William Gagne, Patricia Grimes de Naranjo, Chad Messick, and Julia Vertrees. Dermatopathologists: Michael Piepkorn (Bellevue, Wash) and Clifton White (Portland, Ore). Data and Safety Monitoring Board: Robert Lew (Boston, Mass), Irwin Braverman (New Haven, Conn), Bernard Cole (Lebanon, NH), Richard Kalish (Stony Brook, NY), David McLean (Vancouver, BC, Canada), and Bruce Thiers (Charleston, SC).

  2. ‡

    This article is US Government work and, as such, is in the public domain in the United States of America.

Publication History

  1. Issue published online: 20 MAY 2009
  2. Article first published online: 20 APR 2009
  3. Manuscript Accepted: 20 NOV 2008
  4. Manuscript Revised: 14 NOV 2008
  5. Manuscript Received: 25 SEP 2008

Funded by

  • Cooperative Studies Program (CSP) Grant 402 from the US Department of Veterans Affairs Office of Research and Development
  • Summer Research Assistantship Grant from the Alpert Medical School of Brown University
  • Brown University Department of Dermatology
  • National Institutes of Health. Grant Numbers: R01CA106592, R01CA106807, R25CA087972, R01AR49342

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Keywords:

  • actinic keratoses;
  • squamous cell carcinoma;
  • basal cell carcinoma;
  • nonmelanoma skin cancer;
  • epidemiology

Abstract

BACKGROUND:

Actinic keratoses (AKs) are established as direct precursors of squamous cell carcinoma (SCC), but there is significant controversy regarding the rate at which AKs progress to SCC. The authors of this report studied a high-risk population to estimate the risk of progression of AK to SCC and to basal cell carcinoma (BCC) and the risk of spontaneous regression of untreated AKs.

METHODS:

Data were obtained from participants in the Department of Veterans Affairs Topical Tretinoin Chemoprevention Trial. Participants were examined every 6 months for up to 6 years. At each examination, the locations on the face and ears of clinically diagnosed AKs and lesions scheduled for biopsy were marked, and high-resolution digital photographs were taken. These photographs were used later to map and track the presence, absence, or biopsy of each AK across visits.

RESULTS:

In total, 7784 AKs were identified on the face and ears of 169 participants. The risk of progression of AK to primary SCC (invasive or in situ) was 0.60% at 1 year and 2.57% at 4 years. Approximately 65% of all primary SCCs and 36% of all primary BCCs diagnosed in the study cohort arose in lesions that previously were diagnosed clinically as AKs. The majority of AKs (55%) that were followed clinically were not present at the 1-year follow-up, and the majority (70%) were not present at the 5-year follow-up.

CONCLUSIONS:

In the current study, the authors quantified the malignant potential of clinically diagnosed AKs for both SCC and BCC, although many did not persist, and the results suggested that AKs may play a greater role in the overall burden of keratinocyte carcinomas than previously documented. Cancer 2009. Published 2009 by the American Cancer Society.

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