Extract:
“Mitomycin C (MMC) is a DNA-alkylating chemotherapeutic agent mostly used in the treatment of adenocarcinomas of the gastrointestinal tract. Due to its toxicity, inadvertent extravasation of this medication can cause local skin and soft tissue injury. Acute symptoms are mild with erythema, swelling, and pain. Weeks later, indolent ulcerations can appear with severe local necrosis, resembling doxorubicin extravasation. Additionally, rare cases of delayed MMC extravasation reactions have been reported occurring months after infusion and are typically associated with an identifiable effector that alters vascular permeability such as radiation therapy, sunburn, or alcohol.”
“Despite the long-reported cutaneous sequela of extravasated vesicant chemotherapeutics, the pathophysiology remains unknown. Therefore, there are no known therapeutic targets for antidotal intervention, and trialed medical management has been largely ineffective.1 Although some report successful treatment with pyridoxine and dimethylsulfoxide, with or without α-tocopherol, many cases require surgical excision and split-thickness grafts to restore function and prevent structural damage. Improved infusion techniques and fewer extravasation reactions may have contributed to a paucity of literature over the last 2 decades. Consequently, dermatologists must remain aware of this now infrequently seen and already rare manifestation. We present a cluster of 4 cases of MMC extravasation injury, which highlights the varied array of time courses and locations of the disease.”
Reference:Mieczkowska K, Deutsch A, Amin B, Mir A, Abraham R, Balagula Y, Blasiak R, Mann RE, Patel P, Musaev T, Zhu TH, Kalnicki S, Packer SH, McLellan BN. Mitomycin extravasation injury: A case series. JAAD Case Rep. 2021 Jul 13;15:69-72. doi: 10.1016/j.jdcr.2021.06.029. PMID: 34409144; PMCID: PMC8361222.