Voriconazole is a widely used and highly effective azole antifungal agent. Its associated adverse events include liver damage and abnormal vision. Photosensitivity may also develop in some patients. A 73-year-old woman developed malignant lymphoma approximately 9 years earlier, and had been in remission after chemotherapy and hematopoietic stem cell transplantation. She had been taking 200 mg/day of voriconazole to treat pneumomycosis for approximately 3 years and 8 months. Around the summer of 2017, erythema was noted on the face and an elevated lesion developed on the left cheek. Therefore, she was referred to the department of dermatology. Tissue biopsy of the elevated lesion demonstrated squamous cell carcinoma, but no metastases were found by whole-body search. Thereafter, she developed recurrent squamous cell carcinomas of the face and both hands, underwent multiple surgical resections, chemotherapies, and treatments using topical products, and her symptoms improved. The mechanism of voriconazole-induced skin carcinogenesis is unknown. However, experimentally, the antifungal agent exhibits phototoxic effects in a concentration-dependent manner. Therefore, it is important that patients taking voriconazole be instructed to carefully protect exposed areas from sunlight, and be followed-up regarding photosensitivity symptoms.
