A case of markedly impaired wound repair with angiostatic pazopanib in a patient who had Mohs surgery for a basal cell carcinoma

Author:

Nahm William J1ORCID,de Imus Gail2,Mathe Christopher A3,Saap Liliana4,Joseph Saiyan5,Chen Stanley6ORCID,Falanga Vincent7

Affiliation:

1. NYU Grossman School of Medicine, New York, NY, USA

2. Dermatology and Skin Surgery, Providence Medical Group, Mukilteo, WA, USA

3. California University of Science and Medicine School of Medicine, Colton, CA, USA

4. Skin Unlimited, New Braunfels, TX, USA

5. Boston University, Boston, MA, USA

6. Massachusetts Institute of Technology, Cambridge, MA, USA

7. Department of Dermatology, Dartmouth-Mary Hitchcock Medical Center, Lebanon, NH, USA

Abstract

This case report highlights the adverse effects of pazopanib, a vascular endothelial growth factor receptor inhibitor, on wound healing after Mohs surgery. A 79-year-old male with metastatic renal cell carcinoma of the lung, on 600 mg daily pazopanib, underwent Mohs surgery for a nodular basal cell carcinoma on his right leg. Despite multiple wound care strategies, his wound deteriorated over 4 months. Discontinuing pazopanib resulted in rapid wound closure within 2 months. However, metastatic lung nodules grew, prompting treatment with immune checkpoint inhibitors, nivolumab, and ipilimumab, which were discontinued due to complications. Near-complete wound healing was observed prior to reintroducing pazopanib (6 months after initial discontinuation), which again led to wound deterioration. Pazopanib negatively impacts wound repair by inhibiting cell proliferation and angiogenesis. Depending on the malignancy or tumor, cessation of pazopanib, or switching to a course of immune checkpoint inhibitors may be warranted perioperatively.

Publisher

SAGE Publications

Subject

General Medicine

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