Histologic changes induced in skin by extravasation of doxorubicin (adriamycin)

Extravasation of doxorubicin in skin and soft tissue causes necrosis and ulceration. These ulcers form slowly and heal with great difficulty. The cause of ulceration is not known. Histologic changes in two patients suggest that an exaggeration of interface dermatitis like epidermal changes may be responsible for epidermal necrosis. This process may be enhanced or complicated by ischemic changes caused by thrombosis of the venous tributaries at the site of the intravenous infusions. Squamous syringometaplasia seen in both cases can be confused with squamous cell carcinoma. Dermal changes mimic those seen in radiation injury.