Doxorubicin and Unusual Skin Manifestations

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Abstract
To the Editor.— Doxorubicin hydrochloride (Adriamycin), an anthracycline antibiotic that has a broad spectrum of antitumor activity, has been widely used as a single agent or in combination with other drugs.1 The major toxic side effects have been nausea, vomiting, mucosal ulcerations, alopecia, hematopoietic depression, and cardiomyopathy. I would like to report two unusual melanotic cutaneous reactions related to doxorubicin therapy. Fig 1.—Black hyperpigmentation on palm. Fig 2.—Black hyperpigmentation on nails and nailbeds. Report of Cases.—Case 1.— A 55-year-old black woman was referred for chemotherapy for metastatic breast carcinoma. In November 1973, she underwent radical mastectomy for carcinoma of the left breast, with an uneventful recovery. In May 1974, an epidural metastasis developed, with compression of the spinal cord at the T-4 and T-5 levels. Laminectomy was performed and she was subsequently treated with cyclophosphamide (Cytoxan), methotrexate, vincristine sulfate, fluorouracil, and prednisone.2 After further progression, with an appearance

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