Oral prevention of skin cancer

Multiple studies have been conducted to evaluate the potential role of chemoprevention of skin cancer; Dr Yolanda Gilaberte Calzada (Miguel Servet University Hospital, Spain) provided a thorough overview of findings to date [1].  

The most robust evidence is for the use of acitretin; current guidelines recommend its use for the prevention of squamous cell carcinoma in organ transplant recipients.

An observational study of nearly 44,000 Australians divided subjects into groups according to risk, with high-risk defined as having a history of skin cancer excisions or >5 actinic keratosis (AK) lesions, and low-risk defined as having no history of skin cancer excisions and ≤5 AK lesions. At 3-year follow up, those in the high-risk group who took non-steroidal anti-inflammatory drugs (NSAIDs) at least weekly showed a decreased risk of basal cell carcinoma but not squamous cell carcinoma; those who took aspirin less than weekly showed a decreased risk of squamous cell carcinoma but not basal cell carcinoma. In the low-risk group, there was no association between the use of NSAIDs or aspirin and basal cell carcinoma or squamous cell carcinoma risk.

Multiple investigations into the chemoprevention of melanoma using multiple agents have yielded inconclusive results.

A phase 3 trial of nicotinamide for skin cancer prevention showed some promising results but only in the short term; beneficial effects declined within 6 months of discontinuing nicotinamide. However, there may be some role for the use of nicotinamide in prevention of AK in transplant recipient patients.

While some modest risk reduction of skin cancer is seen with the use of metformin, it is not considered statistically significant.

A systematic review on the use of capecitabine concluded that its use may reduce AK, basal cell carcinoma, and squamous cell carcinoma in organ transplant recipients; however, multiple adverse effects warrant diligent consideration.

Furthermore, there is a paucity of robust research on the capacity of phytochemicals to prevent skin cancer, with one notable exception: Dr Calzada encourages us to continue with our daily cup of coffee – there is a 3% reduction in the risk of melanoma associated with the intake of 1 cup of coffee daily.

 

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   1. Gilaberte Calzada Y. Oral prevention of skin cancer. D3T03.1B, EADV Virtual Congres, 29-31 October 2020.

Posted on 2 November 202018 December 2020