Sanjay Sharma M.D.              Washington University
Arsenical keratosis, squamous cell carcinoma and pancreatic adenocarcinoma after 30-40 year ingestion of arsenic  
         
 

This case describes complication of chronic arsenic ingestion in an 83-year-old white female who used arsenic insecticide on her potato plants for approximately 30-40 years. The classic dermatologic findings included palmar arsenical keratosis and squamous cell carcinoma of the hand. In addition, she had pancreatic adenocarcinoma which was complicated by duodenal invasion resulting in a fatal GI bleed. The association of this latter malignancy with arsenic exposure is unclear. After extensive review of the literature, it appears that ingestion has generally been limited to poisonings, industrial exposure, insecticide exposure, ingestion form contaminated well water, iatrogenic consumption from Fowler’s solution once widely used to tread psoriasis, and Chinese herbal medicines. The documented complications in chronic use include dermatologic changes as described in this patient, multiple internal malignancies, and hepatic dysfunction. There is a renewed interest in the use of arsenic for acute promyelocytic leukemia. Although it is doubtful that the internist will see a marked increase in toxicity, especially chronic manifestations, the findings as described in this patient are classic and thus, easy for the internist to identify.