Hyperkeratotic papules may develop on the palms and soles years after arsenic ingestion. A mottled pigmentation may occur on the trunk like raindrops on a dirt road and Mees' lines may develop on the nails. SCC's, BCC's (especially of the pigmented type), gangrene of the feet, and in particular multiple Bowen's disease lesions are typical. The urine may be assayed for the presence of the arsenic which presently is occasionally found in well water in some parts of the world (e.g., Taiwan).
Internal malignancy may also develop (most commonly liver and lung cancers). Nasal septum perforation is associated.
Close monitoring and therapy of any cutaneous tumors is essential. Keratolytics, cryotherapy, CD, or 5-FU may be prescribed for the arsenical keratoses. A podiatrist to routinely debride the lesions is also helpful. Surveillance for internal malignancy is important.
Long 20-year history of these. Virtual Grand Rounds in Dermatology
Mottled pigmentation of the trunk. Nasza Dermatologia