Paradoxical effect of epinephrine on lesion redness and vascularity Journal Article


Authors: Nazir, Z. H.; Rishpon, A.; Kose, K.; Marghoob, N. G.; Liopyris, K.; Navarrete-Dechent, C.; Dusza, S. W.; Daoud, A.; Marghoob, A. A.
Article Title: Paradoxical effect of epinephrine on lesion redness and vascularity
Abstract: Introduction: Epinephrine is commonly used in combination with local anesthetic (lidocaine/epinephrine) due to its beneficial vasoconstrictive properties. Typically, pallor is appreciated after injection as a sign of effect; however, we observed that some cutaneous malignancies paradoxically revealed increased redness and vascularity after injection of lidocaine/epinephrine. In this study, we investigate this phenomenon among a series of biopsied lesions to identify characteristics of lesions associated with increased redness and/or vascularity. Objectives: To determine characteristics of lesions which become redder or more vascular after injection with lidocaine/epinephrine prior to biopsy. Methods: This cross-sectional study consisted of a convenience sample of lesions scheduled for biopsy. Lesions were photographed prior to and 7 min after injection of lidocaine/epinephrine as a part of standard care. Two readers blinded to study objectives and histopathological diagnosis assessed lesions for changes in redness and vascular features. Results: Fifty-four lesions from 47 patients—61.7% male, mean age 64.8 years, age-range 24–91 were included. Thirty-six lesions were biopsy confirmed malignant, with 5 in situ and 31 invasive malignancies; the remaining 18 lesions were benign. In comparison with non-malignant lesions, malignant lesions were associated with an increase in clinically appreciable vascular features after injection of lidocaine/epinephrine, X2 (1) = 21.600, p < 0.001. Further stratification into benign, in situ, and invasive lesions strengthened the association, X2 (1) = 23.272, p < 0.001. Conclusions: Combination lidocaine/epinephrine has been shown to paradoxically increase the visibility of vessels seen in cutaneous malignancies. This is consistent with prior literature suggesting aberrant adrenergic signaling in neoangiogenic vessels. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Keywords: adult; clinical article; human tissue; aged; histopathology; squamous cell carcinoma; melanoma; dermoscopy; basal cell carcinoma; skin biopsy; skin defect; skin cancer; epiluminescence microscopy; health care quality; pilot study; cross-sectional study; lidocaine; skin redness; local anesthetic agent; skin blood flow; epinephrine; human; male; female; article; anesthetic; paradoxical drug reaction
Journal Title: Archives of Dermatological Research
Volume: 315
Issue: 7
ISSN: 0340-3696
Publisher: Springer  
Date Published: 2023-09-01
Start Page: 2145
End Page: 2147
Language: English
DOI: 10.1007/s00403-023-02524-6
PUBMED: 36826508
PROVIDER: scopus
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in PubMed and PDF -- Corresponding author is MSK author: Ashfaq A. Marghoob -- Source: Scopus
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MSK Authors
  1. Stephen Dusza
    289 Dusza
  2. Ashfaq A Marghoob
    534 Marghoob
  3. Kivanc Kose
    82 Kose
  4. Ayelet Rishpon
    10 Rishpon
  5. Zaeem Nazir
    11 Nazir
  6. Alexander Abel Daoud
    1 Daoud