Interventions for preventing non‐melanoma skin cancers in high‐risk groups
Abstract
Background
Some groups of people have a greater risk of developing common non‐melanoma skin cancers (NMSC).
Objectives
To evaluate interventions for preventing NMSC in people at high risk of developing NMSC.
Search methods
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 Pharmaceutical companies were contacted for unpublished trials.
Selection criteria
Randomised controlled trials of adults and children at high risk of developing NMSC.
Data collection and analysis
Two review authors independently selected studies and assessed their methodological quality.
Main results
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.
Authors' conclusions
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.
PICOs
Plain language summary
Interventions for preventing of non‐melanoma skin cancers in high‐risk groups
Non‐melanoma skin cancer is still the most common cancer in the UK, the United States and Australia. 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. Very few studies have been conducted in people at increased risk of NMSC.
For people with Xeroderma pigmentosum (a rare inherited genetic skin disorder) topical application of T4N5 liposome lotion is beneficial in reducing the rate of appearance of new basal cell carcinomas, however it may increase the risk of a new squamous cell carcinoma. Acitretin in renal transplant recipients may be of some benefit, however, high doses of acitretin are associated with an increased number of adverse events. Retinol or a reduced fat diet may be worth trying for people with a history of non‐melanoma skin cancer. Further prevention studies for people at increased risk of non‐melanoma skin cancer are needed.
