The incidence of cutaneous squamous cell carcinoma in patients receiving voriconazole therapy for chronic pulmonary aspergillosis

Purpose: Voriconazole has been associated with cutaneous squamous cell carcinoma
(cSCC) in transplant patients but less is known about the risk in other groups. The aim
of the study was to estimate the incidence of cSCC after voriconazole exposure in
patients with chronic aspergillosis. Method: The notes of patients seen at a tertiary
referral centre from 2009 to 2019 with chronic pulmonary aspergillosis were reviewed
for the diagnosis of cSCC and voriconazole use documented. Results: Among 1111
patients, 668 (60.1%) received voriconazole for longer than 28 days. Twelve patients
received a diagnosis of cSCC; nine had used voriconazole. Mean duration of
voriconazole use was 36.7 months. The crude incidence rate was 4.88 in 1000
person/years in those who had voriconazole and 2.79 in 1000 patient/years in those
who did not receive voriconazole for longer than 28 days. On Cox regression, age (HR
1.09, 95% CI 1.02-1.16, p=0.01) and male gender (HR 3.97, 95% CI 0.84-18.90,
p=0.082) were associated with cSCC. Voriconazole use was associated with a slightly
increased risk, which was not significant (HR 1.35, 95% CI 0.35-5.20,p=0.659).
Conclusion: Voriconazole use beyond 28 days did not lead to a significantly increased
risk of cSCC in a large cohort of patients with chronic pulmonary aspergillosis.