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Bleomycin is one of the widely-used chemotherapeutic agents. It may cause non-specific changes in the skin including stomatitis, hair loss, nail changes, inflammatory nodules, multiform erythema and vesicobullous eruptions. Cutaneous flagellate pigmentation on pressure or trauma sites is known as specific cutaneous reaction to bleomycin, although its pathomechanism is not clearly elucidated. We experienced a rare flagellate pigmentation due to bleomycin injection in a patient with metastatic testicular tumor. A 25-year-old male showed linear brown flagellate pigmentations on the trunk, axillae, dorsa of hands, which were developed after BEP(bleomycin. etoposide, cisplatin) combination chemotherapy. He underwent left radical orchiectomy and artificial testicular replacement because of metastatic testicular endodermal sinus tomor(stage D_2). Gentle rubbing or scratching on the skin caused linear brownish edema and residual pigmentation. Histopathologic finding of the pigmented sites revealed melanin pigmentation of basal cell layer and patchy pigmentation of low prickle cells. The flagellate pigmentation became paler during 7 months follow-up period. Authors report a cutaneous flagellate pigmentation after bleomycin chemotherapy.
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