The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

Chemotherapy-Induced Hyperpigmentation
of the Tongue

A B

A
Marcelo Blaya, M.D. fter undergoing breast lumpectomy and biopsy of the sentinel
Nakhle Saba, M.D. lymph nodes, a 42-year-old woman with triple-negative invasive ductal carci-
Tulane University
noma began adjuvant chemotherapy with doxorubicin, cyclophosphamide, and
New Orleans, LA paclitaxel. After the second cycle of doxorubicin and cyclophosphamide, asymptomatic
mblaya@tulane.edu hyperpigmented macules and patches were noted on the patient’s tongue (Panel A).
There was no hyperpigmentation of the palms, soles, dermal creases, or nails, and
the remainder of the physical examination was normal. Dermal hyperpigmentation
is a well-known adverse effect of a number of chemotherapeutic agents and has been
reported to occur in association with both doxorubicin and cyclophosphamide. The
condition may be local or generalized and may affect skin, mucous membranes,
nails, or hair. The underlying mechanism remains uncertain. In this patient, the tongue
lesions started to fade after the completion of therapy and disappeared almost com-
pletely within 12 weeks (Panel B).
Copyright © 2011 Massachusetts Medical Society.

e20 n engl j med 365;10  nejm.org  september 8, 2011

The New England Journal of Medicine

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