HCC Patient on Sorafenib Develops Two Nodules

A 68-year-old man developed hepatocellular carcinoma associated with chronic alcohol abuse and cirrhosis. He began to receive sorafenib (400 mg twice daily) as management for advanced disease when both pulmonary and osseous metastases appeared. About 8 weeks after drug initiation, the patient noted the rapid onset of two nodules nearly identical in appearance: one on the arm and one on the temple. The latter is depicted above. Both lesions were mildly tender to palpation. Neither lesion was associated with regional lymphadenopathy. Aside from concern about these lesions, the patient was tolerating the sorafenib well and had no other relevant complaints. Family history, past medical history, and social history were unremarkable or not pertinent.