Voriconazole is a triazole antifungal agent approved to treat serious fungal infections. Although generally well tolerated, adverse effects include visual disturbances, gastrointestinal complaints, and cutaneous eruptions. Photosensitivity, pseudoporphyria, photoaging, and premature dermatoheliosis have been described. In this case series, Miller et al describe 5 melanoma in situ lesions arising in 2 patients undergoing long-term voriconazole treatment. The duration between therapy initiation and melanoma onset was short, and the clinically severe phototoxic effects and photodamage are clinically reminiscent of xeroderma pigmentosum. A better understanding of the pathophysiologic basis for voriconazole-associated phototoxic effects may provide valuable insight into the contribution of UV light to melanoma genesis.
The recommended biopsy technique for suspected melanoma is excision with narrow margins. Partial biopsy techniques (such as punch or shave) may lead to histopathologic misdiagnosis through unrepresentative sampling, yet the risk of melanoma misdiagnosis has not been clearly established. In this prospective case series, Ng et al demonstrate that punch biopsy was associated with significantly increased histopathologic misdiagnosis (false positive and false negative). Punch and shave biopsies also reduced microstaging accuracy. Whenever possible, excisional biopsy should be used to sample suspected melanomas.
Hydroxyurea (HU) is an antimetabolite commonly used in treating hematologic and oncologic conditions. Mucocutaneous adverse effects are common with HU, and in this case report, Kalajian et al describe an 82-year-old woman undergoing long-term HU therapy who developed a dermatomyositis-like eruption (DM-LE) and later developed aggressive squamous cell carcinomas. Reevaluation of the initial biopsy specimens for DM-LE revealed focal epidermal p53 staining, which may represent a precursor to HU-associated nonmelanoma skin cancers. The authors suggest a heightened level of scrutiny when encountering cases of DM-LE in patients undergoing long-term HU therapy.
Mathematical modeling of early surveillance incidence data might project a nonmelanoma skin cancer (NMSC) incidence of 2 million yearly today. This is substantially higher than recent estimates of annual NMSC incidence, most likely because it failed to account for the risk of an individual developing multiple NMSCs over a lifetime. Stern developed a mathematical model using age-specific incidence data adjusted to reflect changing incidence over time, the age distribution of the population, and the likelihood that an incident tumor was the first ever for an individual. This model indicates that the prevalence of skin cancer is far higher than that of any other cancer and exceeds that of all other cancers diagnosed since 1975.
Melanoma poses a significant health threat as the sixth most commonly diagnosed skin cancer in the United States. The elderly population is of particular interest because of the disproportionate increase in deaths in patients with melanoma who are 65 years or older. In this database analysis, Seidler et al assessed health care resource consumption for these patients, allowing for an estimate of national annual resources consumed. Early-stage melanoma costs appear similar to those of prostate cancer, while late-stage melanoma costs resemble those of colon cancer. Policy guidelines for melanoma screening should consider that patients 65 years or older represent an increased risk and economic burden for later-stage melanoma.
This Month in Archives of Dermatology. Arch Dermatol. 2010;146(3):231. doi:10.1001/archdermatol.2010.21