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Skin carcinogenesis can be divided into at least three major stages: initiation, promotion, and progression. In the mouse skin model, the first stage is thought to involve the interaction of a tumor initiator with the genetic material of stem cells, leading to an irreversible alteration in growth control or differentiation, probably by activation of the Ha-ras oncogene. The major effect of all skin-tumor promoters seems to be the specific expansion of the initiated stem cells. The correlation between the abilities of tumor promoters to induce sustained hyperplasia and their tumor-promoting activities is very good. We found that the appearance of alpha-glutamyl transpeptidase (GGT) and keratin 13 and the lack of expression of keratins 1 and 10 are good markers for skin tumor progression. These alterations occur when papillomas change from a diploid to an aneuploid state, mainly as a result of developing trisomies 6 and 7. To evaluate the role of GGT in skin-tumor progression, we transfected a functional GGT cDNA into two cell lines that normally produce papillomas when grafted into the skin of nude mice. When injected subcutaneously, all of the GGT-transfected clones formed malignant tumors, whereas only 24% of vector-transfected cells did. When GGT-transfected clones were placed into grafts, the grafts had an average mass almost three times that of grafts of vector-transfected cells. Our recent studies also suggest that the ribonucleoprotein telomerase and the gap-junctional proteins connexins (Cxs) are also important in skin-tumor progression. A progressive increase in telomerase activity was associated with the increased level of genomic instability …