Skin Cancer Lesions Not Affected By Agent Orange Exposure Interview with:
Naveed Nosrati MD

Indiana University School of Medicine
Staff Surgeon, Roudebush VAMC

Medical Research: What is the background for this study?

Dr. Nosrati: We originally began this study as a broader project investigating the effect of trauma induced by biopsies on the spontaneous clearance of a non-melanoma skin cancer. As part of that, we created a large database with many patient variables. Since we undertook this project at our local VA hospital, one of the variables available to us was Agent Orange exposure.

Shortly after completing the study, Clemens et al published their study linking Agent Orange exposure to higher rates of invasive non-melanoma skin cancer. Their study was a pilot study of only 100 patients. As we had well over 1,000 patients, we decided to pursue a side project of how Agent Orange specifically affects our results.

Our study was operating under the hypothesis that trauma induced by biopsies led to an inflammatory response that often led to the immunologic clearance of the remaining skin cancer. We actually coined the term “SCORCH” lesion, or spontaneous clearance of residual carcinoma histologically, for this phenomenon. With that mind, we would expect patients exposed to Agent Orange to theoretically have a more invasive form of malignancy and thus have lower rates of spontaneous clearance.

After we crunched the numbers we found that rates of clearance between those veterans exposed and not exposed to Agent Orange was the same. In fact, the rate was slightly higher in the exposed group, though this wasn’t significant. This was a very interesting result, especially in light of the other recent study. However, we can’t be too quick to jump to conclusions when comparing the studies. The two studies analyzed different variables and outcomes, and the only link is a theoretical hypothesis. What conclusion can be made though, is that SCORCH lesions aren’t affected by Agent Orange.

Medical Research: What future research do you recommend as a result of this work?

Dr. Nosrati: Future directions of this project are to compile all the variables within the database to create a system that better predicts when a lesion will be a SCORCH lesion. We are currently undertaking that task, as well as prospectively collecting data that puts that system to the test.

The Effect of Agent Orange on Nonmelanoma Skin Cancer Regression Rates
Nosrati N, Han J, Flores R, Sood R, Tholpady SS.
JAMA Surg. 2014 Nov 1;149(11):1205-6. doi: 10.1001/jamasurg.2014.953.