Dermatology: Practical and Conceptual


Dermatology Practical & Conceptual

Letter  |  Dermatol Pract Concept. 2021.11(3): e2021043 1

Bevacizumab-Induced Geographic Tongue
Marta Martinez-Garcia, Jorge Roman-Sainz, Nicolás Silvestre-Torner, Sergio Tabbara Carrascosa

Dermatology Service. Severo Ochoa University Hospital, Leganés, Madrid

Key words: Bevacizumab, geographic tongue, self-solving, infiltrating ductal carcinoma, vascular endothelial growth factor protein

Citation: Martinez-Garcia M, Roman-Sainz J, Silvestre-Torner N, Tabbara Carrascosa S. Bevacizumab-induced geographic tongue. 
Dermatol Pract Concept. 2021.11(3): e2021043. DOI: https://doi.org/10.5826/dpc.1103a43

Accepted: November 23, 2020; Published: July 8, 2021

Copyright: ©2021 Martinez-Garcia et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original 
authors and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Marta Martínez García, Dermatology Service. Severo Ochoa University Hospital, Leganés, Madrid.  
E-mail: martamgml@yahoo.es

Introduction

Geographic tongue condition, or benign migratory glossitis, 

is a self-limited and often recurrent process, which occurs 

in around 2.5%. of the general population. The diagnosis is 

clinical and is characterized by the presence of atrophic areas 

located on the back and lateral edges of the tongue, caused 

by the absence of filiform papillae. Its cause is unknown, it is 

associated with multiple systemic diseases and occasionally 

with drug use.

Case Presentation

Here we present a case of a 43-year-old patient diagnosed 

with infiltrating Ductal Carcinoma. 1 year later, he presented 

tumor recurrence and treatment was started with capecitavin 

(1500 mg/m2 for 14 days) and bevacizumab (15 mg/m2 every 

21 days), obtaining complete remission. In the last 12 months 

he underwent maintenance therapy with bevacizumab (15 

mg/m2/21 days). In the last quarter of the last 12 months the 

patient reported the appearance of migratory lesions located 

on the back of the tongue, which evolved in outbreaks and 

were accompanied by pain and stinging with the ingestion of 

certain foods. The patient reported no clear relationship with 

the administration of bevacizumab. 

On the first examination, several atrophic plaques were 

observed, surrounded by a slightly elevated, white, keratotic 

border, arranged in a concentric fashion (Figure 1). Following 

2 follow-up months, an additional examination was per-

formed. A notable spontaneous improvement of the lesions 

was observed (Figure 2).

Conclusions

The association of the geographic tongue condition with 

the use of bevacizumab, whose target is the vascular endo-

thelial growth factor protein A (VEGF-A), has recently been 

described [1]. VEGF-A activity blockade could impede the 

normal reparative capacity of the epithelium at the level of the 

lingual mucosa, which could explain the development of these 

lesions. The increasing use of this type of drug as a treatment 

for multiple tumors might facilitate the appearance of new cases 

of geographic tongue. An in-depth knowledge of the recently 

described association of the geographic tongue condition follow-

ing bevacizumab use will prevent misdiagnosis and unnecessary 

treatment in these patients, who are often immunosuppressed.



2 Letter  |  Dermatol Pract Concept. 2021.11(3): e2021043

References

1. Sundar S, Burge F. Geographical tongue induced by ax-

itinib. BMJ Case Rep. 2015; 2015:bcr2015211318. 2015 Oct 

16. DOI:10.1136/bcr-2015-211318. PMID:26475876

Figure 1. Atrophic plaques surrounded by a keratotic border Figure 2. Improvement of lesions