Retinoid chemoprevention in the high-risk patient,☆☆,

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XP: A MODEL FOR SKIN CANCER CHEMOPREVENTION

In an effort to determine whether isotretinoin could be effective chemoprevention of skin cancer in high-risk patients, a study was designed involving patients with XP. XP is a rare, autosomal recessive disorder. Cells from patients with XP have been demonstrated to have abnormalities in the ability to repair UV radiation-induced DNA damage. Clinically, these patients manifest exaggerated skin damage in response to UV exposure. At a young age they may have photosensitivity, with exaggerated

RETINOID CHEMOPREVENTION IN THE NBCC SYNDROME

The NBCC syndrome is an autosomal dominant disorder that includes developmental abnormalities in addition to multiple BCCs. Patients with this syndrome usually have a triad of odontogenic keratocysts of the jaw, palmar/plantar pits, and multiple BCCs. They may also have structural abnormalities of the ribs, calcification of the falx cerebri, and other developmental abnormalities. Large numbers of BCCs develop in some patients with NBCC, and the high frequency of new tumors causes difficulties

RETINOID CHEMOPREVENTION IN ORGAN TRANSPLANT RECIPIENTS

Because of progressive surgical advances in transplantation and growing expertise in the achievement of sustained immune suppression, successful organ transplantation has become common. Organ transplant recipients routinely look forward to long life expectancies that allow for an active lifestyle with full participation in outdoor activities. This has led to a rapidly expanding population worldwide of immunosuppressed organ transplant recipients—a population at high risk for the development of

GUIDELINES FOR SKIN CANCER CHEMOPREVENTION WITH ORAL RETINOIDS

Several studies have shown the efficacy of oral retinoids used as chemopreventive agents against skin cancer. However, their benefits do not persist after the discontinuation of therapy.

Long-term retinoid therapy, especially at high doses, has been associated with skeletal toxicity, such as calcification of tendons and ligaments around joints, and hyperostoses of the spine.18, 19, 20, 21, 22, 23 More recently, long-term exposure has been associated with osteoporosis.24 This is of particular

FUTURE PROSPECTS

Clearly there is an expanding population of organ transplant recipients who are at high risk for the development of skin cancer. Furthermore, the SCCs that occur in this population can behave aggressively and cause significant morbidity. New retinoids with a better efficacy/toxicity ratio are urgently needed to provide chemoprevention to meet this emerging role for retinoids.

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References (24)

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    Chemopreven-tion of skin cancer in xeroderma pigmentosum

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  • KH. Kraemer

    Xeroderma pigmentosum: a prototype disease of environmental-genetic interaction

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  • Cited by (0)

    Reprint requests: John J. DiGiovanna, MD, Department of Dermatology, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.

    ☆☆

    (J Am Acad Dermatol 1998;39:S82-5.)

    0190-9622/98/$5.00 + 0  16/0/91352

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