Arsenical Keratosis Follow-up

  • Author: from Memorial Sloan-Kettering - Chih-Shan Jason Chen, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Oct 28, 2010
 

Further Outpatient Care

Regular skin surveillance and physical examination are necessary for patients who present with cutaneous lesions of chronic arsenicalism because aggressive squamous cell carcinoma may evolve de novo or from existing arsenical keratoses or Bowen disease.

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Deterrence/Prevention

Educate patients on early detection and avoidance of arsenic exposure. Identify possible exposure sources in the environment (eg, arsenic-contaminated drinking water, plywood containing arsenic). Advise patients to avoid taking herbal medicine with uncertain arsenic content. Evidence suggests smoking may have additional effect on arsenic induced skin lesions. Smoke cessation and sun protection may modify the damage of arsenic toxicity.[7]

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Complications

Arsenical keratosis occasionally evolves into carcinoma after a number of years. Bowen disease is the most common form of skin cancer induced by arsenic exposure. Arsenical squamous cell carcinoma occurs less frequently than Bowen disease, but it appears to be more aggressive than sun-induced squamous cell carcinoma. Previous reports have shown a much higher incidence of fatal metastases among patients with arsenical squamous cell carcinoma.

A variety of internal cancers due to arsenic ingestion have been reported. The presence of arsenic-induced cutaneous Bowen disease has been viewed as a cutaneous marker of possible internal malignancy, but this issue is still controversial.

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Prognosis

Arsenical keratosis is not a fatal disease, but it may persist indefinitely and can become bothersome over time because of pain, bleeding, fissuring, and ulceration.

A dose-response relationship exists between arsenic exposure and health effects. Exposure to higher concentrations of arsenic and a longer duration of exposure to arsenic may increase the risk of invasive skin cancers and internal malignancies, which may result in fatality.[34]

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Patient Education

For patient education material, visit eMedicine's Cancer and Tumors Center, as well as Skin Cancer and Skin Biopsy.

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Contributor Information and Disclosures
Author

from Memorial Sloan-Kettering - Chih-Shan Jason Chen, MD, PhD  Associate Attending, Dermatology Service, Memorial Sloan-Kettering Cancer Center; Director, Dermatologic Surgery and Mohs Micrographic Surgery Unit, MSK Skin Cancer Center; Chief, Dermatologic Surgery, Northport Veterans Affairs Medical Center

from Memorial Sloan-Kettering - Chih-Shan Jason Chen, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Society for Dermatologic Surgery, Association of Professors of Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel Mark Siegel, MD, MS  Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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