Antineoplastic agent-associated serpentine supravenous hyperpigmentation: superficial venous system hyperpigmentation following intravenous chemotherapy.

PURPOSE: To review the clinical characteristics and associated antineoplastic agents in patients who developed hyperpigmentation of the superficial venous system after chemotherapy.

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.