Chronic phototoxicity and aggressive squamous cell carcinoma of the skin in children and adults during treatment with voriconazole
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.
aDermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
bDepartment of Dermatology, University of California, San Francisco, California
cDepartment of Dermatology, Duke University Medical Center, Durham, North Carolina
Correspondence 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.
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.
ABSTRACT