Multiple epidermal cysts in a hepatocellular carcinoma patient taking Nexavar®

An epidermal cyst is a keratin-filled lesion lined by an epidermis and presents as a single or multiple intradermal or subcutaneous mass. Sorafenib (Nexavar ®, BAY 43-9006) is a tumor angiogenesis inhibitor that is used for treatment of hepatocellular and renal cell carcinomas. Sorafenib can cause a variety of cutaneous toxicities - hand-foot skin reaction (HFSR) and non-hand-foot skin reaction (non-HFSR). Symptoms of HFSR include paresthesia, tingling, burning or painful sensations of both palms and soles, and a decreased tolerance to hot objects. Non-HFSR cutaneous toxicities include yellow discoloration of the skin, alopecia, stomatitis, subungual splinter hemorrhages, facial swelling, keratoacanthomas, leukocytoclastic vasculitis, genital lesions, facial erythema, nevi, lentigenes, epidermal inclusion cysts, xerosis, etc. To our knowledge, the occurrence of epidermal cysts after sorafenib intake is very rare and has not yet been reported in Korea. Herein, we report a rare case of a hepatocellular carcinoma patient with multiple epidermal cysts following sorafenib intake.