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Basil M. Hantash, MD, PhD; Daniel B. Stewart, MD, PhD; Zachary A. Cooper, MD; Wingfield E. Rehmus, MD, MPH; R. James Koch, MD; Susan M. Swetter, MD

Arch Dermatol. 2006;142:976-982.

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.

Design  Randomized, prospective 5-year trial.

Setting  Dermatology and otolaryngology clinics of a Veterans Affairs hospital.

Patients  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.

Interventions  Carbon dioxide laser resurfacing, 30% trichloroacetic acid peel, or 5% fluorouracil cream applied twice daily for 3 weeks.

Main Outcome Measures  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.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.

Conclusion  All 3 modalities demonstrated benefit for AK reduction and skin cancer prophylaxis compared with controls and warrant further study in a larger trial.

Author Affiliations: Departments of Dermatology (Drs Hantash, Stewart, Cooper, and Swetter) and Otolaryngology (Dr Koch), Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif; and Department of Dermatology, Stanford University Medical Center, Stanford, Calif (Drs Hantash, Stewart, Cooper, Rehmus, and Swetter). Dr Koch is now with the California Face and Laser Institute, Palo Alto.

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