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Squamous cell carcinoma secondary to arsenic keratoses in a father and son

Authors: Jennifer Aileen Ang-Tangtatco, MD, DPDS; Karen Lee Alabado, MD, FPDS and Lalaine Visitacion, MD, FPDS


Arsenic is categorized as a class I human carcinogen by the International Agency for Research on Cancer and chronic exposure to its inorganic form have been associated with a variety of diseases. Its effect on the skin is the most sensitive endpoint of arsenic exposure and dermal manifestations include arsenic keratoses, a premalignant lesion and considered a diagnostic criterion of arsenic toxicity. We report two cases of chronic arsenic poisoning in a father and son who presented with a history of hypo- and hyperpigmented macules and patches over the body and multiple hyperkeratotic papules over the palms and soles, progressing to ulceration. All other family members, except for one, also had the pigmentary changes on the body and palmoplantar hyperkeratosis. Histopathology results of the ulcerated lesions of both patients were consistent with squamous cell carcinoma. Surgical interventions, oral retinoids, and nutritional buildup were done. The patients are being followed up every six months to monitor cancer progression and internal organ involvement. These cases highlight the role of occupational and environmental exposure to arsenic as an important risk factor in developing keratoses and cancer.



Ang-Tangtatco, JA, Alabado, KL & Visitacion, LV. (2017). Squamous cell carcinoma secondary to arsenic keratoses in a father and son. Journal of the Philippine Dermatological Society, 26(1), 69-73.



arsenic, arsenic keratoses, squamous cell carcinoma

  1. Caussy D. A Field Guide for Detection, Management and Surveillance of Arsenicosis Cases. World Health Organization Regional Office for Southeast Asia. 2005:1-38.
  2. Martinez V, Vucic E, Becker-Santos D, Gil L, Lam WL. Arsenic Exposure and the Induction of Human Cancers. Journal of Toxicology. 2011 May; 431287:13.
  3. Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions and Malignancies: A Systemic review of the Global Incidence. Curr Environ Health Rep. 2015 March; 2(1):52-58.
  4. Mandal BK, Suzuki, KT. Arsenic around the world: a review. Talanta. 2002 February; (58):201-235.
  5. Ilagan KA, chief editor. Philippine Center for Investigative Jornalism : 19892016. Chronic illnesses on the rise in Marcopper towns; 2008 November. Available from:
  6. Cabaero N, chief editor. Sunstar Manila Local News : DOH on alert vs arsenic contamination in Central Luzon; 2016 June. Available from: http://
  7. International Agency for Research on Cancer (IARC). Some drinking-water disinfectants and contaminants, including arsenic. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. 2004; 84:269-477.
  8. Yu HS, Liao WT, Chai CY. Arsenic carcinogenesis in the skin. Journal of Biomedical Science. 2006 September; 13(5):657-666.
  9. Goldsmith L, Katz S, Gilchrest B, Paller A, Lefell D, Wolff K. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York: McGraw-Hill; 2008.
  10. Jackson R, Grainge JW. Arsenic and cancer. CMA Journal. 1975 Sept; 113(5):396401.
  11. Chen SJ, MD and Elston D, chief editor. Medscape : WebMD LLC; 19942015. Arsenical Keratosis; 2014 December. Available from: http://emedicine.
  12. Ramirez P, Del Razo LM, Gutierrez-Ruíz MC, Gosenbatt ME. Arsenite induces DNAprotein crosslinks and cytokeratin expression in the WRL-68 human hepatic cell line. Carcinogenesis. 2000 April; 21:701-706.
  13. Martinez V, Becker-Santos D, Vucic E, Lam S, Lam WL. Induction of Human Squamous Cell-Type Carcinomas by Arsenic. Journal of Skin Cancer. 2011 Oct; 454157:9.
  14. Jensen T, Novak P, Eblin KE, Gandolfi AJ, Futscher BW. Epigenetic remodeling during arsenical-induced malignant transformation. Carcinogenesis. 2008 Aug; 29(8):1500-1508.
  15. Karagas M, Tosteson TD, Blum J, Klaue B, Weiss J, Stannard V, et al. Measurement of Low Levels of Arsenic Exposure: A Comparison of Water and Toenail Concentrations. American Journal of Epidemiology. 2000 July; 152(1):84-90.
  16. Hall M, Chen Y, Ahsan H, Ahsan H, Slavkovich V, van Green A, et al. Blood arsenic as a biomarker of arsenic exposure: Results from a prospective study. Journal of Toxicology. 2006 May; 225(2-3):225-33.
  17. Khandker S, Dey RK, Islam AM, Ahmad SA, Mahmud IA. Arsenic-safe drinking water and antioxidants for the management of arsenicosis of patients. Bangladesh J Pharmacol. 2006 Dec; 1(2):42-50.

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Squamous cell carcinoma secondary to arsenic keratoses in a father and son