Skin Hypopigmentation in a Patient with Papillary Carcinoma Thyroid Treated with Sorafenib

Abstract

Sorafenib is an oral multikinase inhibitor approved for the treatment of advanced renal
cell carcinoma, hepatocellular carcinoma and thyroid cancer. The dermatological side effects
of sorafenib include palmar-plantar erythrodysesthesia, alopecia, skin rash, pruritus, xeroderma
and erythema. Here we report a case of skin hypopigmentation related to sorafenib therapy.
A 60 year old male with papillary carcinoma of thyroid with cervical lymph nodal
metastasis, post thyroidectomy and Iodine-131 ablation therapy developed lung metastasis.
As the lesions were not iodine avid, he was started on sorafenib. After 4 months of treatment
with 800 mg/day he developed hypopigmentation of the skin, prominently on the forehead,
neck, hands and feet. He was also having grade 2 mucositis, so dose was reduced to 400 mg/
day. Later his disease progressed, so sorafenib was discontinued. However, the hypopigmented
lesions persisted.
Hypopigmentation as a potential side effect of sorafenib has rarely been reported in
literature. Close collaboration between oncologists and dermatologists is needed to improve in
the characterization and the management of cutaneous side effects of Sorafenib.