Agent Orange Exposure Appears to Double Risk of Invasive Skin Cancer

By Annette M. Boyle

Mark Clemens, MD

Mark Clemens, MD

HOUSTON — Even four decades later, veterans exposed to Agent Orange during the Vietnam War have twice the risk of developing unusually invasive nonmelanotic skin cancers compared with the general population, according to a recent study.

“We noticed a lot of veterans coming into our clinic had very aggressive squamous and basal cell carcinomas, and it seemed like there was a connection to Agent Orange exposure, but a literature search failed to find any studies that showed an association in humans,” said Mark Clemens, MD, assistant professor of plastic surgery, University of Texas M.D. Anderson Cancer Center. Previous studies have demonstrated a positive correlation between 2-, 3-, 7-, 8-tetrachlorodibenzodioxin (TCDD), the highly toxic contaminant in Agent Orange and nonmelanotic invasive skin in animals.

As of 2009, more than 485,000 veterans with Agent Orange exposure had registered with the VA. DoD and the VA recognize and provide benefits for many TCDD exposure-associated diseases, including peripheral neuropathy, amyloidosis, B-cell leukemia, birth defects, chronic lymphocytic leukemia, type 2 diabetes mellitus, Hodgkin and non-Hodgkin lymphoma, ischemic heart disease, multiple myeloma, Parkinson’s disease, porphyria cutanea tarda, prostate cancer, respiratory cancers, soft-tissue sarcomas and chloracne.

A U.S. Huey helicopter spraying Agent Orange over Vietnam.

A U.S. Huey helicopter spraying Agent Orange over Vietnam.

Currently, however, skin cancer is not presumptively associated with Agent Orange exposure. The latest Institute of Medicine update to the Veterans and Agent Orange report concluded that there is “inadequate and insufficient information to determine whether there is an association between exposure to Agent Orange and basal cell or squamous cell cancer.”1

That didn’t dissuade the M.D. Anderson researchers from further investigation.

“In our clinic, we talked about an association on a daily basis. We wanted to systematically take the first step toward conclusively making that case,” Clemens said. “We did a pilot study with 100 consecutive patients and found a surprisingly high rate of 51% of veterans had nonmelanotic skin cancer, which is about twice what you would see in an age-matched cohort in the general population,” Clemens told U.S. Medicine.

The researchers evaluated the medical records of patients who enrolled in the Agent Orange registry at the Washington, DC, VAMC from August 2009 to January 2010. The patients ranged in age from 56 to 80 years old, with a mean age of 65.7 years. Only patients with Fitzpatrick skin types I-IV (fair to medium complexions) were included in the study. The results of the study appeared in the February issue of Plastic and Reconstructive Surgery.2

“We compared whether they sprayed fields every day, lived and worked in the area or traversed a field once as part of work and then looked at the incidence by group,” Clemens said. Among the 30% of patients who actively sprayed Agent Orange, the risk of skin cancer was even higher — 73%. Of those who lived or worked in areas sprayed with the chemical, 46% had nonmelanotic invasive skin cancer (NMISC). For veterans who reported only traveling through areas exposed to Agent Orange, the rate dropped to 21%.

About 43% of patients had chloracne, known to be caused by dioxin exposure. The presence of chloracne increased the rate of NMISC substantially, to 80%. Cutaneous melanoma occurred in 9% of the patients, similar to the 8.8% rate seen in individuals over the age of 65 in the general population. More than one-fourth of the patients (26%) had other malignancies.

Men with lighter skin and light eye color also had increased risk. Of the 14 men with Fitzpatrick skin type I, the lightest, 10 (71%) had NMISC. Just under 60% of those with Fitzpatrick skin type II and 45% of those with type III had NMISC, while none of those with skin type IV did. Of the 38 veterans with blue eyes, 66% (25) had NMISC, as did 60% (9) of those with green or hazel eyes. The incidence rate was much lower in veterans with brown eyes, at 36%.

“The takeaway from the study is that there may be an association between Agent Orange and development of nonmelanotic skin cancer, but it needs to be studied on a larger scale with thousands of patients. What we’ve observed is very, very suspicious and supports what’s been reported anecdotally,” Clemens noted.

Clemens said he and his colleagues are hoping to enroll patients in a larger, prospective study. The researchers pointed out that their study had some significant limitations, such as reliance on recalled TCDD exposure and the absence of a control group of nonexposed Vietnam-era veterans.

While research continues, Clemens encouraged physicians to closely monitor veterans with Agent Orange exposure for skin cancers.

“Most patients in this group don’t fall under the screening regimen. They may not have a family history of skin cancer; they’re over 65. Even if there isn’t a formal screening recommendation, veterans exposed to Agent Orange should have a physician look them over from head to toe and check any areas where they might have skin cancer,” he suggested.

“It’s difficult with just 100 patients to stratify subcohorts to determine who is most or least at risk, but the incidence was clearly higher among individuals with fair skin and light eyes,” Clemens added. “We can say that we really need additional study to determine the relative risk within this group and how we might best help these veterans.”

National Research Council. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press, 2014.

Clemens MW, Kochuba AL, Carter ME, Han K, Liu J, Evans K. Association between Agent Orange Exposure and Nonmelanotic Invasive Skin Cancer: A Pilot Study. Plast Reconstr Surg. 2014 Feb;133(2):432-7.

Comments (25)

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  1. Thomas Lucken says:

    Not just Vietnam! Korean DMZ veterans were exposed not only during the token presumptive dates of 68 to 71. But till 1991, when we turned the American sector over to the ROKs!!!!!

    VA/Feds admit to use on DMZ and admit that dioxins remain present in ground/soil for decades. But refuse to admit that us soldiers were exposed to that very soil till 1991.

    Now many of us are battling A.O. illnesses and many more don’t even know they were exposed.

  2. mark beynart says:

    I was in RVN from 11/70 to 11/71 and was based at Quang Tri province at a small airfield. I contracted choroidal Melanoma in 2008. I did an FOIA request and the numbers of vet’s that had been diagnosed with Choroidal Melanoma were staggering—the numbers for Veterans were off the scales. Number of occurrences were 5-6 per million citizens nationwide–we had about 300M citizens as of the last census-or about 15-18 cases a year for non Veterans. My eye was removed in 2012. there were about 20M Veterans–ir 1/15 of the civilian population
    With 300M citizens they had 15 to 18 cases per million annually. Foia requested documents shows the VA treated in 2007–1967 Vets, 2008–2092 Vets, 2009–2237–2010-2067 and 2011 1577 Vets. I”ll be glad to send anyone this report if they are interested. If 15 times the normal occurrence for any type cancer is unusual–I think someone should do more investigating.

    • Robert Barnhill says:

      I was in the Brown Water Navy in the Mekong Delta 68-69. I have been fighting basal and squamous cell skin cancers sine 1978. I currently have a claim in with the VA which they denied. No surprise. I am going to fight it as far as I can go. For the past two years I have had to under go some type of surgery at the rate of one each quarter.

      I would appreciate a copy of the report.


    • Dave Chapman says:

      Hi Mark,
      I was sorry to read of the loss of your eye, etc. After reading your post I am hoping you could advise me on how I could finalize my claim, if you would be so inclined. My situation is that as a Vietnam Vet from 1966-1970 I was exposed to AO. In 2014 I had 4 eye surgeries at the VA on my left eye. Although I still have my eye I am considered blind in that eye. I also had a squamous cell cancer diagnosis on my left lower leg. When diagnosed it was smaller than the size of a pencil eraser but would not heal so I went to have it looked at immediately and it was diagnosed as squamous cell cancer. The VA made me wait almost 4 mo for surgery to remove it and by then it was over 2″ in diameter and to get it all out they had to go down to the bone and scrape cells. I then needed a skin graft to repair the gaping hole. I applied for benefits on the cancer in Nov ’14 and their response was I needed to send medical journal articles that proved AO was the cause of my cancer. I have never smoked and no one in my family has had any cancer. I believe I should receive compensation but it is being denied. I would appreciate your sending any articles that might help my claim. I worked on PBR’s in the Delta region in and out of the water pretty continually. I haven’t been able to find specific articles that I think they would accept as proof. Thank you for your time.
      Dave Chapman

  3. ervin nordmann says:

    I was also located in the Mekong Delta with HAL 3 seawolves. I have been fighting the skin cancer battle and have more scares than I can count. It is a shame the politicians really dont give a crap about veterans, they all should be sprayed with agent orange and have to go through with what all veterans go through and maybe they might have a different view.
    Maybe with the overhaul of the VA things might change, I guess since all these conflicts were never declared an official war they think all vets are just another number. Put all vets in congress and that will be a WAR we can win.

  4. Frank Van Camp says:

    US army at Long Binh 1968-69. Numerous basil cell, squamous and melanoma cancers. Most had to be removed surgically. Member NJ Agent Orange Point Man Project. Why cannot Congress and Senate spend money on those who deserve it instead of “feel good get re-elected” projects. Cut the waste and abuse and spend to cure and help those who earned and deserved it.

    • Bill Carpenter says:

      Also US army at Long Binh 1968-69. Also have history of malignant skin growths. Was a supply expediter for the 92nd Engineers. Transported drums of herbicide that would fall off truck and saturate our feet. I transported supplies all over South Vietnam and would spot spraying operations I know I was also exposed to.

  5. Tom Harper says:

    I served in DaNang from 1967 to end of 1968. I have had Basil Cell on my upper right arm, squamous on the back of my left hand and Basil cell on my scalp. All three were removed by surgery. In addition I have had Ocular Melanoma(my claim was denied) in both eyes and prostate cancer. I am convinced that these health problems are related to agent orange in Vietnam and the US Army Chemical school. I was also expose to solvents on a daily basis during my years as a company armorer. I also had liquid Mustard gas applied to the back of my hands. We need better research.

    • SEdge says:

      My father served in Vietnam and had been pretty healthy until about 7 years ago when he went blind in his left eye. The VA said they could find nothing wrong with it. He continued to work as he typically had until about six months ago when the pain from his eye became too much. Long story short, he now had melanoma in his eye and lung. How can this not be AO and how do we prove it?

  6. Steve Wiese says:

    I served in RVN from 11/69 thru 12/70 in the First Cavalry Division. Being in the Cav we moved around frequently and many of the areas I was in I don’t recall.

    Since the late 80’s I have had no less than 250 skin cancers surgically removed. I also had my prostate removed due to prostate cancer in 2001. I firmly believe the numerous skin cancers are related to Agent Orange. Who do I go to regarding this concern?

    I currently receive disability for the prostate cancer but feel the skin cancer is also tied to this.


    Steve W.

  7. Arden Jensen says:

    I was an 11B who was in and on the Korean DMZ (2/9 inf.) from July 1969 through August 1970. I have squamous cell carcinoma. Neither my mother nor my father, who mowed yards for a living in Miami, Florida, and was thus exposed to massive amounts of sun, had skin cancer.

  8. RRichards says:

    Served with 101st Airborne in I Corp, mainly north of Phu Bia and out of Camp Evans, ’69-’70 although I did spend . Just had my second Melanoma removed in six months going back to Oct 2014. Statistics for survival with ‘second occurrences’ of this cancer is very low. 6 mos. to 15 mos.! With the numbers the VA has on these types of cancer I can’t understand why they’re dragging their heels on giving these types cancer ‘service connection’ for Agent Orange! How many have to die before they do? I have two new grandsons that it looks like I won’t be around to watch grow up much…. :( We’re not just numbers like they think, we’re actual people, with families! Wake up VA!

  9. Tom LaPenter says:

    I served 67-68 in I corp USMC. Moved around a lot do to assigned to explosives unit. I just finished up with lower eye lid surgery 1 to remove basal cell and 2 to repair eye lid. lots of cells removed from my arms, another on my chest, several on my face and next my scalp.
    Also lost half my colon to cancer another surgery and two other liver surgeries to remove tumors. All has been denied by VA. Don’t they think we are so tired of all the cover ups over the years.

  10. Richard Donegan says:

    I was security forces with the Air Force in Tuy Hoa AB, 68-69. AO was stored on our base and was sprayed around it 17 times in time I was there. Because of the heat the 55 gallon drums leaked but we were told there was no problems. I walked thru dried AO on the ground at the ammo dump each evening when I went to get napalm that overflowed its containers because of the heat, to take to the guys in bunkers and towers for the evening shift.
    I’ve had 7 basil and squamous cell carcinomas removed from my legs, two over my right eye and many others removed from my arms and back. All denied.
    I also have peripheral neuropathy in my feet, legs, hips, hands and now starting up my arms. Denied because it wasn’t reported within a year of service in Vietnam, although no one knew what it was then and it wasn’t even approved by the VA as a presumptive disease until 1984.
    What we all need are examples of where the VA has approved these type of claims. I did a FOIA request for my claim file and got it on a CD – all 1,394 pages. Most of the documents were duplicates and even triplicates of the same thing – just enough to take a week or so to finally find out their thinking (or lack thereof) as to why they denied these. I found they didn’t take them into any type of study, just denied immediately because they weren’t on the presumptive list, and, in the case of my neuropathy, just denied immediately because I didn’t report it within one year of my service.
    I know some vets have won cases like this on appeal never on immediate claim) so how do we get copies of these cases?

    • Lawrence Shelton says:

      Go to the internet and search for ” V A CITATIONS ON AGENT ORANGE AND (your disorder…melanoma etc) they will discuss the reasons why the claim was approved or denied. Both are important to review. Generally wins are supported by proper medical backup.

  11. Dennis R. Skelton says:

    I was in Viet Nam (1970-1971). I have had several basal cells removed. I filed a claim with the VA in 2011 and was denied. I too believe more research needs to be done on this. I also had a brother die of lung cancer and (viet nam 1969-19700 we are still in the process of working through the claim process with the VA.

  12. Paul H Weisenberger says:

    I spent two tours in Viet Nam. Can Tho Aug 1968 to aug 1969

    Long Than Jan 1972 to Mar 1972 then Da Nang area from Mar 1972 to Dec 1972

    In 2007 I was treated for Basal Cell Carcinoma using Mohs micrographic surgery

    Then Jan 2015 I was treated 1st with Mohs micrographic surgery and then referred to cancer specialist for Radiation Treatment

  13. Michael Rohde says:

    I served with Australian Forces in Phuoc Tuy province (now called Ba Ria Province) in 1971. Over the years, I have had numerous squamous cell skin cancers removed from my arms and face, including about 1/3 of my bottom lip. I have a fair complexion.

  14. John Shoemaker 66-67 says:

    AO testing! I worked with a vet who was a Ranch Hand, they sprayed the stuff. He informed me that every five years the Air Force would send him to San Diego for testing. They would take fatty tissue from the buttock’s area & test it for dioxin.
    They would take the parts per million found & multiply it by the number of years you left country.
    Haven’t heard anything about this from the VA.

  15. mark beynart says:

    I’ve been fighting the VA for 7 years for compensation for multiple skin cancers, PTSD, choroidal melanoma which cost me my eye, and a few other issues. A week ago I received another denial for benefits.
    I’m not done yet–the VA gave me lots of pain meds after a surgery
    I had for a perforated colon after they did a colonoscopy. Now they have my problems list includes drug abuse, alcohol abuse, I don’t drink anymore, cannabis abuse–don’t smoke anymore, nicotine abuse-don’t smoke cigarettes anymore and a few more abuse problems. I guess all Vietnam vet’s have some problems but mine are many


  16. Jillian Cordova says:

    All of this is very interesting. My father did two tours in Vietnam (unfortunately, not sure of dates or particular locations) and passed away almost eight years ago due to complications from metastatic ocular melanoma. Never once did we attribute it to exposure to Agent Orange until a friend of the family suggested it. Can any of you provide me more information from what you have found? He was first diagnosed back in 1999, had eye removed and then was essentially in remission until 2006 when it first mets to his lungs followed by liver and spine. Thank you so much for your time.

    • Robert Selby says:


      Did you ever receive any information from other veterans concerning your father’s ocular melanoma? I, too, have ocular melanoma and I am trying to find any information I can about it. It appears that a significant amount of people have lost their eye to Agent Orange. Any help that you can provide, I would definitely appreciate. Thank you for your time and understanding. Additionally, please accept my condolences for your father passing.


  17. Martha says:

    My husband was in Vietnam and was exposed to agent orange, he developed diabetes and then basil cell carcinoma on his face, later developed malignant melonima which killed him. I only hope the VA will at some point be held responsible for this horrible disease

    • DON says:

      Mary, I’m so sorry for your loss. I was in Vietnam 1971-1972. The doctors have surgically removed numerous basil and squamous cell cancers from my head, face, chest, and leg. I am a survivor of stage 4 throat cancer. After learning from others that I should file an Agent Orange claim for my “upper respiratory” and skin cancers, I did so in November 2015, along with numerous other duty related issues. Last week, I received a denial from VA on my claims for upper respiratory throat aND skin cancers, along with denials for orher claims. The denial stated that since the upper respiratory cancer started in my tonsils, it does not qualify. I am ecstatic to have survived this dreaded desease, but I, too, would love to see that our government takes responsibility for those they send into harms’ way. A VA doctor even had the audacity to tell me that the VA does not approve claims for upper respiratory cancers if they originate anywhere above the larynx. As mentioned, VA also denied my claim for skin cancers, even though the MD Anderson Cancer Center in Houston has published articles in medical journals that link skin cancers to agent orange exposure.

      A former VA doctor who is currently treating me for skin cancers told me that it was all about the numbers. In other words, VA will continue to deny claims until the numbers are fiscally manageable. Of course, that means a lot of us have to die first. So sad.

      So I just lost my first few battles; albeit, the war rages one.

      Have an outstanding and safe 2016.

  18. Jerry Lynch says:

    USAF, in country 71-72 near Saigon. I’ve had 14 separate incidents of basal cell and squamous cell skin cancers, all over (neck, throat, face, back, ears, forehead, chest). I included this info with paperwork I submitted to the VA for other maladies and was categorically denied any benefits for skin cancer.

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