Arsenic-related Bowen's disease and paraquat-related skin cancerous lesions show no detectable ras and p53 gene alterations

We have investigated point mutations of codons 12, 13, and 61 in H-, K-, and N-ras oncogenes as well as p53 tumour suppressor gene exon 5 through exon 9 by PCR-SSCP analysis in 26 skin biopsy tissues from 16 arsenic-related Bowen's disease patients and 6 skin samples from 4 paraquat manufacturing workers. No mutation was found. These results are different from findings with UV associated skin cancers. Interestingly, a silent change at codon 27 of H-ras in one allele was detected in all 4 paraquat manufacturing workers and in 2 of 16 arsenic-related Bowen's disease patients. It is likely that the molecular mechanisms involved in arsenic and paraquat induced skin cancers differ from sunlight-related skin malignancies.

Progressive alterations of cytokeratin expressions in the process of chronic arsenism

Recent studies of an endemic occurrence of chronic arsenism in a limited area on the southwest coast of Taiwan are focusing on its cytokeratin analysis in hopes of tracing the disease's biochemical expression. Specimens were obtained from uninvolved skin and arsenical cancers including Bowen's disease, basal cell carcinoma, and squamous cell carcinoma. In this study, we used two-dimensional polyacrylamide gel electrophoresis to analyse cytokeratin expression. Progressive alterations in cytokeratin expression were found in various skin lesions. These include an expression of K16 in the uninvolved skin; K16 and K6 in Bowen's disease; and K16, K6 and K17 in squamous cell carcinoma and basal cell carcinoma. In addition, we found that the K1 isoelectric variants shifted to more acidic forms with the complete absence of K1 in basal cell carcinoma. K16 expression in uninvolved skin indicates that it is nevertheless in a hyperproliferative status. K17 was expressed in squamous cell carcinoma and basal cell carcinoma, but not in Bowen's disease. The progressive impairment of phosphorylation of K1 and K2 in the process of chronic arsenism provides us with a suitable model for studying the biological significance of phosphorylation in intermediate filaments during chemical carcinogenesis.

Alterations of mitogenic responses of mononuclear cells by arsenic in arsenical skin cancers

We have studied the endemic occurrence of chronic arsenism in a limited area on the southwest coast of Taiwan. The effects of arsenic on the mitogenic responses of mononuclear cells (MNC) derived from patients with arsenical skin cancers in that area were evaluated. The subjects enrolled in this study included patients with 1) Bowen's disease, 2) arsenical skin cancers (basal cell carcinoma and squamous cell carcinoma), 3) non-arsenical skin cancers (basal cell carcinoma and squamous cell carcinoma), 4) nasopharyngeal cancer and 5) healthy controls from endemic and non-endemic areas. Phytohemagglutinin (PHA) stimulated [3H]thymidine incorporation in MNC in all groups except the arsenical skin cancer group. However, when a low concentration of As2O3 (2.5 x 10(-7) M) was added to PHA-stimulated MNC, a tremendous amplification of the uptake of [3H]thymidine was noticed in patients with arsenical skin cancer. In this study, this phenomenon did not occur in cancers not related to arsenic. This result shows that arsenical carcinomas are hyperreactive to its specific etiology--arsenic. Arsenic seems to play a role as a co-stimulant of PHA similar to interleukin-1.

Alterations of skin-associated lymphoid tissue in the carcinogenesis of arsenical skin cancer

We investigated the skin-associated lymphoid tissue in arsenical skin cancers, including 14 Bowen's disease, 6 basal cell carcinoma and 6 squamous cell carcinoma patients from an endemic area by immunohistochemical and morphometric methods. There was a progressive decrease of Langerhans cells in the order of normal skin, normal appearing edge and arsenical cancers. A disruption of the uniform Langerhans cell dendrites was also noticed. The Langerhans cell density in arsenical tumors did not correlate with the peritumoral infiltrates. The prominent infiltrated cells in the peritumoral area had T cell markers. The number of peritumoral T lymphocytes in squamous cell carcinoma was significantly less than that of Bowen's disease and basal cell carcinoma. Peritumoral mononuclear infiltrates in Bowen's disease and squamous cell carcinoma showed a higher helper/suppressor T cell ratio than that in basal cell carcinoma. This may be accounted for by a selective increased recruitment of helper T cells to the tumor infiltrates in Bowen's disease and squamous cell carcinoma.

Quantitative and morphological changes of Langerhans cells in Bowen's disease from patients with chronic arsenicism

Langerhans cells (LCs) are considered to be responsible for the immunologic presentation of tumor-associated antigens and play a role in the elimination of neoplastic clones. Ultraviolet light B can cause dysfunction and loss of LCs. Both the number and dendritic morphology of LCs are known to be diminished in squamous cell carcinomas from sun-exposed skin. The effects of arsenics on LCs are unknown. Using an OKT-6 monoclonal antibody to stain intraepithelial LCs, we compared their number and morphology in Bowen's lesions and in the perilesional skin from sun-protected sites in ten patients with chronic arsenicism. There was a significant reduction in the numbers of LCs in the Bowen's lesions as compared to the perilesional skin specimens. Loss of dendrites was observed in all Bowen's lesions and in seven of the perilesional skin specimens. Ultrastructurally, the LCs showed an absence of dendrites, but the Birbeck granules were preserved. Since the specimens were not from sun-exposed skin in our study, the findings may be related to chronic arsenic intoxication. The morphologic alteration of LCs observed in the perilesional skin further suggests an arsenic-related systemic dysfunction of the LCs, which in turn may contribute to the development of skin cancers in these patients.

Ureteral tumor with multiple Bowen's disease forty-two years after exposure to arsenic

We report a case of ureteral tumor associated with Bowen's disease in a 67-year-old man. The patient has a history of occupational exposure to arsenic 42 years before. Arsenic produces multiple cancers and these cancers are characterized by a long period of latency.

Arsenic exposure followed by the development of dermatofibrosarcoma protuberans

A case of documented significant arsenic exposure followed by the development of dermatofibrosarcoma protuberans is reported. Exposure to arsenic is associated with an increased chance of the subsequent development of a variety of neoplasms. It is possible that dermatofibrosarcoma protuberans may be one such tumor.

Small cell lung carcinoma and Bowen's disease 40 years after arsenic ingestion

A non-smoking woman presented with ectopic ACTH syndrome associated with disseminated small cell carcinoma of lung. The patient had Bowen's disease and had taken oral arsenic for psoriasis 40 years ago. It is postulated that the previous therapeutic arsenic ingestion caused both her arsenical dermatosis and her small cell carcinoma of lung.

Bowen's disease of the palm

Bowen's disease is a squamous cell carcinoma characterized by isolated, grouped or confluent nodules, either flat, scaling, or crusted, with an arcuate or serpiginous configuration. Malignant dyskeratosis throughout the epidermis, the bowenoid hallmark, is not sufficient by itself to identify a lesion as Bowen's disease. It has been suggested, but not proven, that arsenic has a role in the etiology of Bowen's disease. A case of Bowen's disease affecting the palm, an unusual location, is reported.

Electron microscopic observations of arsenical keratosis and Bowen's disease associated with chronic arsenicism

A 57-year-old man, who had received injections of an arsenide for the treatment of syphilis, developed a tumor on his lower lip and a patchy pigmented lesion on his neck 2 years before the present examination. The lesions enlarged progressively. Under a diagnosis of arsenical keratosis and Bowen’s disease associated with chronic arsenicism, light and electron microscopic observations were made of the lesions. Vacuolated cells were demonstrated by light microscopy, while the characteristic electron microscopic features of both lesions were the appearance of nuclear bodies and the presence of radially arranged, intranuclear inclusion bodies of high electron density.

Premalignant and neoplastic skin lesions associated with occupational exposure to "tarry" byproducts during manufacture of 4,4'-bipyridyl

ABSTRACT Skin lesions have been identified in 20 workers manufacturing 4,4'-bipyridyl. The lesions were on the face, neck, and backs of the hands and arms. Larger localised lesions were removed surgically and examined histopathologically, but other lesions have been treated topically with fluorouracil cream. Histological diagnosis showed a progression from keratosis to Bowen's disease and, in six cases, to squamous cell carcinoma. Over 550 individuals associated with 4,4'-bipyridyl processes between 1961 and 1980 have been examined or questioned. All 20 patients identified worked in now obsolete production plants; 15 of whom were found among the 147 shift process operators. The time taken for the lesions to appear from first working on a 4,4'-bipyridyl plant was 6-19 years (average 12 years). Starting in the early 1960s three processes have been successively used to convert pyridine into 4,4'-bipyridyl. These differ in the reaction conditions used and in the efficiency of the conversion. In the two earlier plants a substantial quantity of pyridine was converted into polypyridyls and “tarry” byproducts, which caused operating difficulties and increased the risk of worker exposure. The exposure and occupational histories of the cases, including the fact that two had worked only on the obsolete production plants, indicates that the causative agent was present in these earlier processes. In-vitro tests for potential carcinogenicity on materials from the present plant and from an earlier process gave positive tests on the tarry byproducts from the earlier process, suggesting that they were the cause of the lesions. Tar impurity production on the present plant is minimal, and worker exposure to chemicals is low. No similar skin lesions have been seen in those who have worked only on the present plant. This observation supports the view that the causative agent was present only on the earlier plants but is not conclusive because of the shorter time that has elapsed since first exposure of personnel who have worked only on the present plant. Medical surveillance of past and present 4,4'-bipyridyl workers is continuing.

Noncirrhotic portal hypertension after arsenic ingestion

Five years after arsenic therapy, the patient described had noncirrhotic portal hypertension, for which he had splenectomy and anastomosis of the splenic vein to the left renal vein. During the 12-year postoperative period he had Bowen's disease (skin carcinoma), but has had normal liver function and no further gastrointestinal bleeding. Arsenic exposure in humans is common throughout the world and may lead to late complications such as noncirrhotic portal hypertension and skin carcinoma, as well as malignancies of the lungs, liver, and lymphatic systems. It may also lead to severe arteriosclerosis with involvement of the heart and extremities.

Bowen's disease of the plantar arch

Bowen's disease has previously been associated with the development of other malignancies particularly in patients with a history of arsenic exposure. A review of the literature is combined with a discussion of current theories regarding arsenic exposure, lesion differentiation, and prognostic implications. This report of a bowenoid lesion of the plantar arch emphasizes the importance of close follow-up of patients with Bowen's disease, especially on unexposed surfaces.

[Syntopy of Bowen's disease and Lewisite scar]

Description of a case of Bown's disease in an area of the right lower leg after lewisite contamination 30 years ago. The possible influence of lost derivatives on carcinogenesis is discussed.