Multiple aggressive squamous cell carcinomas associated with prolonged voriconazole therapy in four immunocompromised patients

Abstract

Rare squamous cell carcinoma (SCC) cases associated with voriconazole therapy have been reported, but this risk may not receive enough consideration from clinicians. We describe four patients presenting with multiple SCC while receiving prolonged (two to three years) voriconazole therapy. Three patients had underwent lung transplantation. SCC were preceded by photosensitization lesions, and predominated in photoexposed area, particularly the face. Therapy associated surgery, chemotherapy in one case, and voriconazole discontinuation; replacement by posaconazole or itraconazole did not trigger other photosensitive lesions. Once voriconazole withdrawn, preneoplastic lesions regressed. In conclusion, prolonged voriconazole therapy may enhance the risk of photoinduced SCC in immunocompromised patients, and skin monitoring is mandatory.

Increased incidence of cutaneous squamous cell carcinoma in lung transplant recipients taking long-term voriconazole

“…This study adds to the emerging literature linking the use of voriconazole to the development of skin cancer. [5][6][7][8][9][10][11][12]16 In addition, all of the deaths attributable to skin cancer (4 of 17 vs 0 of 15 cases) occurred in the voriconazole treatment group. Our study suggests that the skin cancer that developed after transplant while patients were taking voriconazole therapy may be more aggressive in nature, although further data are needed to confirm the association.…”

“…In addition, case reports and single-center studies have documented an association between long-term voriconazole use and an increased incidence of photosensitivity and skin cancer in lung transplant recipients and other immunocompromised patients. [5][6][7][8][9][10][11][12] In 2004, after noting a rise in invasive fungal diseases in our lung transplant patients in both the immediate and long-term post-transplant periods, we initiated a program of routine long-term antifungal prophylaxis using voriconazole in all lung transplant recipients. Before 2004, we used itraconazole for fungal prophylaxis for high-risk transplant patients.…”

New Onset of Keratoacanthomas After Vismodegib Treatment for Locally Advanced Basal Cell Carcinomas: A Report of 2 Cases

“…While keratoacanthomas (KAs) and squamous cell carcinomas (SCCs) have been reported in response to a number of systemic drugs such as vemurafenib, sorafenib, or voriconazole, 1–3 their association with Smoothened inhibitors has not been previously noted. Herein, we report 2 cases of new KAs developing within 2 months of starting vismodegib therapy in individuals with no history of KAs or SCCs.…”

Photosensitivity reactions and skin tumours associated with voriconazole

“…42 Four immunocompromised patients developed multiple squamous cell carcinomas while taking voriconazole for 2-3 years, preceded by photosensitization lesions and predominately found in photoexposed areas, particularly the face. 43 A 56-year-old immunosuppressed woman developed a poorly differentiated squamous cell carcinoma of the left forearm. 44 A 55-year-old man with pulmonary aspergillosis developed a phototoxic reaction after taking voriconazole for a few months, followed by multiple squamous cell carcinomas on sun-exposed skin areas.…”