Vietnam War veterans with prior exposure to Agent Orange may be at higher risk for certain types of skin cancer, a new study suggests.

The study, which appears in the February issue of Plastic and Reconstructive Surgery®, adds to evidence that risk of non-melanotic invasive skin cancer (NMISC) is increased even 4 decades after Agent Orange exposure, with at least some exposed veterans having unusually aggressive non-melanoma skin cancers.

During the Vietnam War, Agent Orange was widely used as a herbicide and jungle defoliant. It has been linked to a wide range of cancers and other diseases, caused by the highly toxic dioxin contaminant TCDD.

Researchers analyzed medical records of 100 consecutive men who enrolled in the Agent Orange registry at the Veterans Affairs Hospital of Washington, DC, between August 2009 and January 2010. Exposure to TCDD consisted of living or working in contaminated areas for 56% of veterans, actively spraying Agent Orange in 30%, and traveling in contaminated areas for 14% The study only included men with lighter skin.

The rate of NMISC in TCDD-exposed veterans was 51%—about twice as high as the rate expected in men of similar age group. The risk of skin cancer increased to 73% for veterans who actively sprayed Agent Orange. Exposed men with the lightest skin types and those with lighter eyes were also at higher risk, the study showed.

Forty-three percent of the veterans had chloracne. For this group, the rate of NMISC was more than 80%.

The rate of malignant melanoma was similar to that expected in men of similar age. However, the article includes two case reports of unusually aggressive NMISC—with numerous recurrences requiring multiple surgeries—occurring in TCDD-exposed veterans.

Cases of “aggressive and diffuse” non-melanoma skin cancers in TCDD-exposed veterans were first reported in plastic surgery journals in the mid-1980s.

The study has some limitations—including the lack of detailed information on TCDD exposure and the absence of a comparison group of Vietnam-era veterans not exposed to Agent Orange.