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


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


CONCLUSIONS
A high index of suspicion for photosensitivity and SCC may be warranted with chronic voriconazole use when used in the setting of concurrent immunosuppression.
Cowen
Edward W
EW
Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: cowene@mail.nih.gov.
Nguyen
Josephine C
JC
Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Miller
Daniel D
DD
Department of Dermatology, University of California, San Francisco, California.
McShane
Diana
D
Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
Arron
Sarah T
ST
Department of Dermatology, University of California, San Francisco, California.
Prose
Neil S
NS
Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
Turner
Maria L
ML
Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Fox
Lindy P
LP
Department of Dermatology, University of California, San Francisco, California.
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced* / Q000453:epidemiology / Q000556:secondary; D002648:Child; D015897:Comorbidity; D004249:DNA Damage / Q000528:radiation effects; D017484:Dermatitis, Phototoxic / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D017809:Fatal Outcome; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D008875:Middle Aged; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects*; D065819:Voriconazole; D055815:Young Adult
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole