Arsenical Keratosis Clinical Presentation

Updated: Mar 17, 2023
  • Author: Chih-Shan Jason Chen, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Arsenical keratoses, skin hyperpigmentation, and several types of skin cancers, including basal cell carcinoma, squamous cell carcinoma, and Merkel cell carcinoma, [42] are skin lesions characteristic of long-term arsenic exposure. A long latency period (years to decades) occurs before the development of these cutaneous lesions. A study in West Bengal, India, has shown an average latency for skin lesions was 23 years from first exposure to arsenic. [37, 21] Chronic arsenic exposure usually does not cause symptoms, and the skin lesions are usually the first sign to manifest clinically.



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. Basal cell carcinoma is also associated with chronic arsenicalism. Skin cancers may develop in areas not exposed to sun light.

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.