Melanoma associated with long-term voriconazole therapy: a new manifestation of chronic photosensitivity.
BACKGROUND
Voriconazole is a triazole antifungal agent approved by the US Food and Drug Administration for serious fungal infections, including with Aspergillus, Fusarium, Pseudallescheria, and Scedosporium species. In initial clinical trials, approximately 2% of patients developed cutaneous reactions, including photosensitivity, cheilitis, and xerosis. Subsequent reports have implicated voriconazole as a cause of severe photosensitivity and accelerated photoaging, pseudoporphyria cutanea tarda, and aggressive squamous cell carcinoma.


METHODS
We report 5 melanoma in situ lesions in the setting of extreme photosensitivity associated with long-term voriconazole therapy.


CONCLUSIONS
We recommend surveillance for skin cancer formation in all patients who require long-term voriconazole treatment, particularly those who manifest signs or symptoms of photosensitivity or chronic photodamage. Further study of the mechanism underlying voriconazole photosensitivity and oncogenesis is warranted.
Miller
Daniel D
DD
Department of Dermatology, University of California-San Francisco, 1701 Divisadero St., San Francisco, CA 94143, USA.
Cowen
Edward W
EW
Nguyen
Josephine C
JC
McCalmont
Timothy H
TH
Fox
Lindy P
LP
D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D002908:Chronic Disease; D003047:Coccidioidomycosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D004423:Ear; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm; D006105:Granulomatous Disease, Chronic / Q000188:drug therapy; D006801:Humans; D008297:Male; D008545:Melanoma / Q000139:chemically induced* / Q000473:pathology; D016921:Meningitis, Fungal / Q000188:drug therapy; D010787:Photosensitivity Disorders / Q000139:chemically induced* / Q000473:pathology; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000473:pathology; D013997:Time Factors; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use; D065819:Voriconazole; D055815:Young Adult
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole