Pazopanib-Related Impairment of Wound Closure post-Mohs Surgery

Background: Pazopanib inhibits tyrosine kinase receptors-vascular endothelial growth factor receptors, platelet-derived growth factor receptors, and c-Kit receptors. These properties of pazopanib result in the inhibition of angiogenesis and cell growth, which are useful at preventing tumor growth and cell proliferation. Although the package insert recommends stopping pazopanib seven days before surgery, there is no clear evidence of pazopanib’s role in the prevention of wound repair. Here we report a patient with delayed wound closure after Mohs surgery while on a course of pazopanib. A 79-year-old- man with a history of metastatic renal cell carcinoma to the lungs and being treated with pazopanib (600 mg/day) presented with a large biopsy-proven nodular basal cell carcinoma (BCC) on the medial aspect of the right lower extremity. He had the BCC removed with Mohs surgery. Due to the resultant large wound size and pazopanib usage, we decided to use a course of slow-release antiseptics, gentle debridement, amnion/chorion membranes, split-thickness allografts, and compression. Even with all these modalities, over four months, his wound enlarged with progressing undermining and necrosis of the wound edge and surrounding skin. After consulting with his oncologist, the pazopanib was discontinued. The patient experienced rapid closure of his ulceration within three months. Patients being treated with pazopanib can display markedly delayed wound closure. Pazopanib negatively impacts wound repair by inhibiting cell proliferation and angiogenesis, making flaps/grafts inappropriate for wound closure post-Mohs surgery. Depending on the tumor, cessation of the pazopanib or switching to immune checkpoint inhibitors may be warranted perioperatively.