Hepatocellular carcinoma probably represents the final step of the effects of the various precipitating agents for porphyria cutanea tarda, such as alcohol, drugs, hormones, and hepatitis C infection. Risk factors associated with its development include male gender, age over 50 years, liver fibrosis or cirrhosis, and a long history (over 10 years) of symptomatic porphyria cutanea tarda.