LOCALIZED CISPLATIN HYPERPIGMENTATION INDUCED BY PRESSURE - A CASE-REPORT

BACKGROUND. The spectrum of side effects induced by chemotherapy inclu des skin hyperpigmentation. This is prone to occur following treatment with alkylating agents and doxorubicin. More recently, hyperpigmentat ion was discovered in patients treated exclusively with intra-arterial cisplatin and was likely to develop over the dorsal surfaces of the h ands and feet, elbows and knees, and operative incisions (trauma). MET HODS, We followed the clinical course of a patient with osteosarcoma t reated with intravenous (i.v.) cisplatin, doxorubicin, and high-dose m ethotrexate. RESULTS, Following two courses of chemotherapy, hyperpigm entation developed along the sides of the thorax juxtaposed to the rub ber shoulder pads of the patient's crutches. It appeared that the pigm entary change was due to localized pressure in the skin of the patient exposed to i.v. cisplatin. CONCLUSIONS. Factors associated with skin hyperpigmentation as a complication of chemotherapy are discussed. We believe chat cisplatin was the major contributing factor. The mechanis m for cisplatin-induced hyperpigmentation is undetermined. However, it has occurred in patients treated exclusively with intra-arterial cisp latin and can possibly be attributed to an effect on the melanocytes. This is supported by experiences in which cisplatin extravasated into the tissues and resulted in a similar phenomenon. Reasons for excludin g doxorubicin and methotrexate as causative agents are presented. (C) 1996 American Cancer Society.