Acitretin is a synthetic retinoid that has been shown in a double-blind, placebo-controlled study to prevent skin cancers and reduce actinic keratoses in immunosuppressed patients who have undergone renal transplantation.1 It has also been successfully used to treat lichen planus in a double-blind, placebo-controlled study of 65 patients.2 Acitretin therapy (20 mg/d) was therefore initiated in our patient, and within 2 months there was marked clearing of his skin lesions. Owing to a rise in his serum triglyceride levels, the acitretin dosage was reduced to 10 mg/d for 1 month, and the decrease in dosage led to an increase in the thickness of 2 of the skin lesions. Biopsy specimens were obtained from both areas and showed lichenoid inflammation with epidermal hyperplasia. One of the biopsy specimens also showed an early well-differentiated squamous cell carcinoma (Figure 4), but this was largely in situ and associated with lichenoid inflammation. As the squamous cell carcinoma was not clinically well defined and the skin lesions had been undergoing progressive regression during acitretin therapy, the acitretin dosage was again increased to 20 mg/d. The triglyceride levels were reduced by diet control. Six weeks later, the areas were no longer indurated. A biopsy specimen obtained from the site of the skin cancer 3 months later showed nonresidual tumor. Because of the continued risk of skin cancers developing in the patient's burn scar, the acitretin therapy was continued at a dosage of 20 mg/d as a chemoprophylactic measure. This regimen has resulted in clearing of the patient's skin lesions and in residual mottled pigmentation over the burn scar (Figure 5). It has been 1 year since the acitretin therapy was initiated, and no further skin cancers have emerged.