Abstract
We present 2 cases of multiple squamous cell carcinomas that arose in sun-exposed areas, which were associated with long-term therapy of the anti-fungal agent, voriconazole.
Case 1 : A 78-year-old Japanese male, who had a history of pulmonary aspergillosis, was referred for evaluation of skin eruptions on his face after voriconazole therapy of 4months. Within 56 months, highly invasive cutaneous lesions developed. A skin biopsy revealed squamous cell carcinoma.
Case 2 : An 81-year-old Japanese male started oral voriconazole treatment with a diagnosis of pulmonary aspergillosis. 18 months after the therapy, he developed skin eruptions scattered over sun-exposed areas of the skin. Within 45 months, several new hyperkeratotic nodules developed from the scaly erythema. Well-differentiated squamous cell carcinoma was subsequently diagnosed.
Although the precise mechanism of voriconazole-induced photosensitivity remains unknown, voriconazole or its metabolites have been shown to have direct and/or indirect phototoxic effects, which may be closely associated with emergence of squamous cell carcinoma in sun-exposed areas of patients treated with voriconazole. Clinicians must keep in mind that long-term voriconazole therapy carries the risk of development of squamous cell carcinoma in sun-exposed areas, particularly in Asians, who tend to have poor CYP2C19 function.
