Journal of the American Academy of Dermatology
Volume 62, Issue 1 , Pages 31-37, January 2010

Chronic phototoxicity and aggressive squamous cell carcinoma of the skin in children and adults during treatment with voriconazole

  • Edward W. Cowen, MD, MHSc

      Affiliations

    • Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
    • Corresponding Author InformationCorrespondence to: Edward W. Cowen, MD, MHSc, Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1908, Bldg 10, Room 12N238, Bethesda, MD 20892.
    • ,
  • Josephine C. Nguyen, MD

      Affiliations

    • Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
    • ,
  • Daniel D. Miller, MD

      Affiliations

    • Department of Dermatology, University of California, San Francisco, California
    • ,
  • Diana McShane, MD

      Affiliations

    • Department of Dermatology, Duke University Medical Center, Durham, North Carolina
    • ,
  • Sarah T. Arron, MD, PhD

      Affiliations

    • Department of Dermatology, University of California, San Francisco, California
    • ,
  • Neil S. Prose, MD

      Affiliations

    • Department of Dermatology, Duke University Medical Center, Durham, North Carolina
    • ,
  • Maria L. Turner, MD

      Affiliations

    • Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
    • ,
  • Lindy P. Fox, MD

      Affiliations

    • Department of Dermatology, University of California, San Francisco, California

Accepted 23 September 2009. published online 09 November 2009.

Background

Voriconazole is a broad-spectrum antifungal agent associated with photosensitivity and accelerated photoaging. A possible link with aggressive squamous cell carcinoma (SCC) has also been reported.

Objective

We sought to determine the incidence and frequency of cutaneous SCC among patients undergoing long-term treatment with voriconazole who also manifest features of chronic phototoxicity.

Methods

We conducted a retrospective review of patients who developed one or more squamous cell neoplasms during long-term treatment with voriconazole at 3 academic dermatology centers.

Results

A total of 51 cutaneous SCC were identified in 8 patients (median age 34.5 years, range 9-54) treated with chronic voriconazole (median duration 46.5 months, range 13-60). Underlying diagnoses included graft-versus-host disease, HIV, and Wegener granulomatosis. Signs of chronic phototoxicity and accelerated photoaging included erythema, actinic keratoses, and lentigo formation.

Limitations

The retrospective nature of the study cannot determine the true population risk of SCC associated with voriconazole therapy. A prospective cohort study is needed.

Conclusion

A high index of suspicion for photosensitivity and SCC may be warranted with chronic voriconazole use when used in the setting of concurrent immunosuppression.

Key words: fungal infection, immunosuppression, photoaging, photosensitivity, phototoxicity, squamous cell carcinoma, voriconazole

Abbreviations used: AK, actinic keratosis, GVHD, graft-versus-host disease, HCT, hematopoietic cell transplantation, NIH, National Institutes of Health, SCC, squamous cell carcinoma, UV, ultraviolet

 

 Dr Nguyen is currently a resident in the Department of Dermatology at the University of Pennsylvania, Philadelphia.

 Supported in part by the Intramural Program of the National Institutes of Health, Center for Cancer Research, National Cancer Institute.

 Conflicts of interest: None declared.

 Reprints not available from the authors.

PII: S0190-9622(09)01232-8

doi:10.1016/j.jaad.2009.09.033

Journal of the American Academy of Dermatology
Volume 62, Issue 1 , Pages 31-37, January 2010