Pharmacological and genetic approaches have shown that prostaglandins (PGs) synthesized by cyclooxygenase-2 (COX-2) have tumor promoting/progression activity in murine skin. To determine whether the EP4 receptor for PGE2 contributes to this tumor promoting/progression activity, EP4 over-expressing mice (BK5.EP4) were generated and subjected to several carcinogenesis protocols. A two-stage 7,12-dimethylbenz[a]anthracene (DMBA)-12-O-tetradecanoylphorbol- 13-acetate (TPA) protocol resulted in 25-fold more squamous cell carcinomas (SCCs) in the BK5.EP4 mice than wild type (WT) mice. A similar increase in SCCs was observed following treatment with DMBA alone (no TPA) and following UV irradiation. DMBA caused a cytotoxicity in BK5.EP4, but not WT mice, that was characterized by increased apoptosis, increased metalloproteinase(MMP)-9 and MMP-7 expression, and sloughing of the interfollicular epidermis, followed by regeneration and SCC development. An analysis of cytochrome P450 levels, wound healing time and keratinocyte stem cells showed no difference between BK5.EP4 and WT mice. A comparison of transcriptomes between BK5.EP4 and WT mice treated with PGE2 showed a significant upregulation of a number of genes known to be associated with tumor development, including interleukin-20 (IL-20), which was verified at the protein level, supporting a pro-tumorigenic role for the EP4 receptor.