From the Guidelines
Hydroxyurea can potentially increase the risk of skin cancer, particularly in patients who receive the medication long-term. Patients taking hydroxyurea, especially those on chronic therapy for conditions like sickle cell disease, polycythemia vera, or essential thrombocythemia, should be aware of this risk. The medication appears to increase sensitivity to UV radiation and may cause DNA damage that contributes to skin cancer development, as suggested by the increased risk of subsequent malignant melanoma after diagnosis of a non-melanoma skin cancer 1. Patients typically take hydroxyurea at doses ranging from 500-2000 mg daily, and the risk of skin cancer seems to increase with longer duration of therapy, particularly after years of use. To minimize this risk, patients on hydroxyurea should practice strict sun protection measures including using broad-spectrum sunscreen (SPF 30+), wearing protective clothing, avoiding peak sun hours, and having regular skin examinations by a healthcare provider, as recommended for patients with a history of cutaneous squamous cell carcinoma 1. Any new, changing, or unusual skin lesions should be promptly evaluated. Despite this risk, patients should not discontinue hydroxyurea without consulting their healthcare provider, as the benefits of treatment often outweigh the risks for the serious conditions it treats.
Some key points to consider:
- The risk of skin cancer in patients taking hydroxyurea is a concern, particularly with long-term use 1.
- Patients on hydroxyurea should be counseled on the importance of sun protection and regular skin examinations 1.
- The medication can increase sensitivity to UV radiation and may cause DNA damage, contributing to skin cancer development.
- Regular skin examinations and prompt evaluation of any new or changing skin lesions are crucial for early detection and treatment of skin cancer.
- The use of hydroxyurea should be carefully weighed against the potential risks, particularly in patients with a history of skin cancer or those at high risk for developing skin cancer.
From the FDA Drug Label
Hydroxyurea is a human carcinogen. In patients receiving long-term hydroxyurea for myeloproliferative disorders, secondary leukemia has been reported. Skin cancer has also been reported in patients receiving long-term hydroxyurea. Advise protection from sun exposure and monitor for the development of secondary malignancies.
Yes, hydroxyurea can cause skin cancer, as it is a human carcinogen and has been reported to increase the risk of skin cancer in patients receiving long-term treatment, especially those with myeloproliferative disorders 2 2.
- Key points:
- Hydroxyurea is a human carcinogen
- Long-term use increases risk of skin cancer
- Patients should be advised to protect themselves from sun exposure and monitored for secondary malignancies
From the Research
Hydroxyurea and Skin Cancer
- Hydroxyurea, a cytotoxic antimetabolite, has been linked to an increased risk of non-melanoma skin cancers (NMSC) in patients with Philadelphia chromosome-negative Myeloproliferative Neoplasms (Ph-MPN) 3, 4, 5, 6.
- The possible risk factors for NMSC in patients taking hydroxyurea include old age, excessive exposure to sunlight, higher doses, and prolonged therapy duration 3.
- Ultraviolet (UV) radiation and hydroxyurea may play a combined role in carcinogenesis, highlighting the importance of periodic dermatologic screening in patients on long-term hydroxyurea therapy 3, 6.
- Studies have reported cases of multiple skin cancers associated with hydroxyurea therapy, with some cases illustrating the late onset of subsequent skin cancers despite discontinuation of therapy 4, 6.
- The association between hydroxyurea and skin cancer is supported by a growing body of evidence, with recommendations for regular dermatologic monitoring and prompt biopsy and accurate diagnosis to prevent the progression of cancer 5, 6, 7.
- Hydroxyurea-induced carcinogenesis can be attributed to both the drug's mutagenic potential and impaired DNA repair following damage by external triggers such as ultraviolet light 6.
- Dermatologists should be aware of the various cutaneous side effects of hydroxyurea, including nonmelanoma skin cancers, and their management, as prompt diagnosis and proper treatment will improve patient outcomes 7.