Multistage carcinogenesis in mouse skin

The mouse skin model of multistage carcinogenesis has for many years provided a conceptual framework for studying carcinogenesis mechanisms and potential means for inhibiting specific stages of carcinogenesis. The process of skin carcinogenesis involves the stepwise accumulation of genetic change ultimately leading to malignancy. Initiation, the first step in multistage skin carcinogenesis involves carcinogen-induced genetic changes. A target gene identified for some skin tumor initiators is c-Ha-ras. The second step, the promotion stage, involves processes whereby initiated cells undergo selective clonal expansion to form visible premalignant lesions termed papillomas. The process of tumor promotion involves the production and maintenance of a specific and chronic hyperplasia characterized by a sustained cellular proliferation of epidermal cells. These changes are believed to result from epigenetic mechanisms such as activation of the cellular receptor, protein kinase C, by some classes of tumor promoters. The progression stage involves the conversion of papillomas to malignant tumors, squamous cell carcinomas. The accumulation of additional genetic changes in cells comprising papillomas has been correlated with tumor progression, including trisomies of chromosomes 6 and 7 and loss of heterozygosity. The current review focuses on the mechanisms involved in multistage skin carcinogenesis, a summary of known inhibitors of specific stages and their proposed mechanisms of action, and the relevance of this model system to human cancer.