Acral keratoses and squamous-cell carcinomas likely associated with arsenic exposure

Abstract

Chronic arsenic exposure is known to induce punctate keratoses with an increased risk of primary squamous-cell carcinoma. Drinking water is currently the major source of arsenic exposure worldwide and is considered one of the most substantial environmental carcinogens. We describe the case of a 61-year-old Hungarian woman with scattered, acral, hyperkeratotic papules and a history of five palmoplantar squamous-cell carcinomas as well as two other extremity non-melanoma skin cancers. Prior to immigration, she had lived in a county of Southern Hungary that is known to have elevated concentrations of inorganic arsenic in the drinking water above the World Health Organization’s current maximum threshold for safety. To date, this report is the first to describe the phenomenon of palmoplantar squamouscell carcinomas in a patient from this region and underscores the importance of vigilant screening in those individuals who have spent substantial time in high-risk regions internationally and domestically.