Arsenical cancer of skin. Histologic study with special reference to Bowen's disease.

Abstract

A total of 238 arsenical skin cancers in 153 patients (98 men and 55 women) were histologically studied; 117 patients (76.47%) were older than 50. Of the 238 lesions, 46 were epidermoid carcinoma, 36 basal cell (23 deep and 13 superficial), 139 intraepidermal (18 type B keratoses and 121 classical Bowen's lesions and variants) and 17 combined forms. Clinically, it was often impossible to differentiate superficial basal cell carcinoma, intraepidermal carcinoma and combined forms. Bowen's variants (10 with squamous eddies, 6 with features of seborrheic keratosis and 5 with horn formation) were described and illustrated. The combined forms were mixtures of superficial basal cell carcinoma, Bowen's lesion or its variants and Jadassohn epithelioma, Among the 36 basal cell carcinomas, ten revealed bizarre multinucleated giant cells and nuclear atypicalities, three in deep and seven in superficial. Arsenical keratoses consisted of benign type A and malignant type B (intraepidermal carcinoma). Among the 81 type A keratoses 57 revealed no cell atypicalities and 24 only mild ones. Relationships of Bowen's lesions to keratoses and to invasive and metastasizing carcinomas and of keratoses type A to type B and to epidermoid carcinomas were discussed.