Atypical cutaneous hyperpigmentation after multiple chemotherapy agents

Abstract

We report a case of cutaneous hyperpigmentation after injection of cisplatin, carboplatin, pemetrexed, and bevacizumab in patient treated for stage IV lung adenocarcinoma. After the 5th cycle, facial and palmoplantar hyperpigmented macules appeared. The histological examination showed a pigmentary incontinence. The appearance of pigmented palmar macules have been described in association with different chemotherapeutic agents, but to the best of our knowledge an association with the drugs that were administered to our patient have never been described. Photoprotected areas were affected as well as photoexposed zones, an uncommon finding. Post chemotherapy histological and immunohistochemistry studies of such hyperpigmentation have rarely been performed, but in the few studies found, the number of melanocytes was stable. However excessive melanin production in the basal keratinocytes was frequently observed. The pigmentary incontinence could be secondary to an accumulation of drugs in the affected areas by sweat excretion and direct cytotoxicity on the melanocytes.

Keywords

• Pigmentation
• Skin toxicity
• Chemotherapy