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Kenneth A. Katz, MD, MSc, MSCE

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Amid continuing controversies over drug safety,^1-2 results of a trial of topical tretinoin—a commonly used medication for acne³ and skin wrinkles, hyperpigmentation, and roughness⁴—raise serious concerns for the public health. The Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) trial^5-6 was a vehicle-controlled randomized controlled trial (RCT) that studied whether topical tretinoin, 0.1%, cream applied to the face and ears could prevent nonmelanoma skin cancer. As reported in an abstract published in 2005,⁶ the study observed 1131 subjects for at least 2 years. After 6 years, and about 6 months prior to the study's scheduled conclusion, a safety monitoring committee stopped the study because of excess mortality among subjects who applied tretinoin (n = 82 deaths [14%]) compared with those who applied vehicle (n = 53 [9%]) (P = .01). Differences in mortality from pulmonary disease (12 vs 4) and non–small cell lung cancer (NSCLC) (11 vs 4) were . . . [Full Text of this Article]

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