Chronic phototoxicity and aggressive squamous cell carcinoma of the skin in children and adults during treatment with voriconazole Edward W. Cowen, MD,

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Chronic phototoxicity and aggressive squamous cell carcinoma of the skin in children and adults during treatment with voriconazole Edward W. Cowen, MD, MHSc, Josephine C. Nguyen, MD, Daniel D. Miller, MD, Diana McShane, MD, Sarah T. Arron, MD, PhD, Neil S. Prose, MD, Maria L. Turner, MD, Lindy P. Fox, MD Journal of the American Academy of Dermatology Volume 62, Issue 1, Pages 31-37 (January 2010) DOI: 10.1016/j.jaad.2009.09.033 Copyright © 2009 Terms and Conditions

Fig 1 Cutaneous manifestations of long-term treatment with voriconazole. A, Patient 1, 9-year-old boy with extensive lentigo formation and multiple actinic keratoses on head and neck after 3 years of treatment with voriconazole. B, Patient 1, Hyperkeratotic lesion with erythema on left side neck. C, Patient 1, Histology of lesion on left side of neck (B) identified acanthotic solar keratosis with acantholysis. Lesion bordered on superficially invasive SCC. D, Patient 3, 22-year-old man with long-standing HIV infection with SCC on left side of neck after 15 months of voriconazole therapy. Chronic phototoxicity with erythema and dark brown lentiginous pigmentation is present on head and side of neck. E, Patient 3, similar erythema and pigmentation resembling xeroderma pigmentosum is present on photoexposed surfaces of back of neck and upper extremities. F, Patient 5, 46-year-old man after 4 years of treatment with voriconazole with recurrent SCC on left preauricular aspect of cheek. Patient subsequently died of metastatic disease. G, Patient 5, histology of SCC from right cheek reveals deeply invasive SCC with keratinocyte pleomorphism, representative of multiple SCC that developed in this patient. (B and G, Hematoxylin-eosin stain; original magnifications: B, ×100; G, ×40.) Journal of the American Academy of Dermatology 2010 62, 31-37DOI: (10.1016/j.jaad.2009.09.033) Copyright © 2009 Terms and Conditions