Antineoplastic Agent-Associated Serpentine Supravenous Hyperpigmentation: Superficial Venous System Hyperpigmentation Following Intravenous Chemotherapy

Abstract

To review the clinical characteristics and associated antineoplastic agents in patients who developed hyperpigmentation of the superficial venous system after chemotherapy. Serpentine supravenous hyperpigmentation was the term coined by Hrushesky to describe increased pigmentation of the skin immediately overlying the venous network used for intravenous infusion of 5-fluorouracil. Subsequently this phenomenon has been observed in individuals treated with other chemotherapeutic agents. A 45-year-old woman with breast cancer who developed serpentine supravenous hyperpigmentation after intravenous 5-fluorouracil is described. Published reports of other individuals who developed antineoplastic agent-associated serpentine supravenous hyperpigmentation are reviewed. Serpentine supravenous hyperpigmentation has most commonly been associated with 5-fluorouracil. Other chemotherapy drugs including alkylating agents, antibiotics, anti-microtubules, and proteasome-inhibitors have also caused this distinctive pattern of pigmentation. Serpentine supravenous hyperpigmentation occurs predominately in men who are receiving treatment for solid tumors. Serpentine supravenous hyperpigmentation is an uncommon sequelae of antineoplastic therapy. Treatment with the associated drug may be continued since this adverse reaction to the chemotherapeutic agent is benign and self-limiting. The hyperpigmented streaks gradually resolve spontaneously after the medication has been stopped.