Bowen's Disease from Pentavalent Arsenic
Patients with multiple SCCIS may have merely gotten their cancers from chronic ultraviolet exposure; like the Sigmund Freud comment "sometimes a cigar is just a cigar", but sometimes there is a more sinister history behind the disease.
In this particular patient's case, he was an asthmatic as a child, and was given (in the 1960's) an oral solution called Fowler's Solution which contained pentavalent arsenic. Starting in the '60s, doctors started noticing that many patients treated with Fowler's Solution were getting multiple SCCIS, and later that was extended to people who were drinking arsenic-laced well water as well. Come to find out, it is primarily pentavalent arsenic that triggers this SCCIS-athon, and I have found multiple SCCIS in patients treated with Fowler's, those who grew up on potato farms (lead arsenate) as well as folks who drank well water. And I'm just one guy...
The big deal is this: exposure to arsenic can also predispose to bladder cancer and in some reports, also certain lung cancers as well. If you have a patient who has multiple SCCIS, ask them about potential exposures, and if they give a positive history, you may want to give their PCPs a heads up.
I gave credit for arsenic, ultraviolet, HPV (including, as one playa noted, occupational exposure to HPV via the World's Oldest Profession). The real reason for the Q was to point out the connection between arsenic and SCCIS and systemic disease. I consider multiple SCCIS to be an external manifestation of systemic disease.
I will be OOT from tomorrow through Monday, and so there will be no Friday or Monday Qs. Enjoy a safe and happy weekend. I'll be at Charlie Gitto's, an Italian resto on "The Hill" in St. Louis, which was allegedly the originator of toasted ravioli. It happens to be my favorite Italian joint on the planet. If any of you are in the neighborhood, stop in!