Use of Arsenic-Induced Palmoplantar Hyperkeratosis and Skin Cancers to Predict Risk of Subsequent Internal Malignancy

• Published in: American journal of epidemiology Vol. 177; no. 3; pp. 202 - 212
• Main Authors: HSU, Ling-I, CHEN, Gwo-Shing, LEE, Chih-Hung, YANG, Tse-Yen, CHEN, Yu-Hsin, WANG, Yuan-Hung, HSUEH, Yu-Mei, CHIOU, Hung-Yi, WU, Meei-Maan, CHEN, Chien-Jen
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 01.02.2013
• Subjects: Adult; Aged; Arsenic Poisoning - epidemiology; Biological and medical sciences; Bowen's Disease - chemically induced; Bowen's Disease - epidemiology; Cohort Studies; Dermatology; Dose-Response Relationship, Drug; Dyskeratosis; Environmental Exposure - adverse effects; Environmental Exposure - statistics & numerical data; Epidemiology; Female; General aspects; Humans; Hyperpigmentation - chemically induced; Hyperpigmentation - epidemiology; Keratoderma, Palmoplantar - chemically induced; Keratoderma, Palmoplantar - epidemiology; Lung Neoplasms - chemically induced; Lung Neoplasms - epidemiology; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasms - chemically induced; Neoplasms - epidemiology; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Skin Neoplasms - chemically induced; Skin Neoplasms - epidemiology; Smoking - epidemiology; Socioeconomic Factors; Taiwan - epidemiology; Tumors; Tumors of the skin and soft tissue. Premalignant lesions; Urinary Bladder Neoplasms - chemically induced; Urinary Bladder Neoplasms - epidemiology; Water Pollutants, Chemical - poisoning; Taiwan; Skin disease; Arsenic; Palmoplantaris; Hyperkeratosis; Internal; Risk; Epidemiology; Skin cancer; Cohort study; Malignant melanoma; Evolution; Hypermelanosis; Public health; Dyskeratosis; Premalignant lesion; Pigmentation disorder; Use; Prediction; non―melanoma skin cancer; Bowen's disease; Bowen disease; Malignant tumor; hyperpigmentation; Risk factor; Skin; internal malignancy; Predictive factor; Cancer
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kws369

Hyperpigmentation, hyperkeratoses, and Bowen's disease are hallmarks of chronic arsenic exposure. The association between arsenic-induced skin lesions and subsequent internal cancers is examined by using a community-based prospective study. The cohort was enrolled from an arseniasis-endemic area in southwestern Taiwan, where 2,447 residents participated in skin examinations during the late 1980s. The number of participants diagnosed with hyperpigmentation was 673; with hyperkeratosis, 243; and with skin cancer (Bowen's disease or non-melanoma skin cancer), 378. Newly diagnosed internal cancers were ascertained through linkage with National Cancer Registry profiles. Cox regression was performed to estimate hazard ratios with 95% confidence intervals for potential risk predictors. Compared with participants without skin lesions, patients affected with skin cancers had a significantly increased risk of lung cancer (hazard ratio = 4.64, 95% confidence interval: 2.92, 7.38) and urothelial carcinoma (hazard ratio = 2.02, 95% confidence interval: 1.23, 3.30) after adjustment for potential confounders and cumulative arsenic exposure. Hyperkeratosis is significantly associated with an increased lung cancer risk (hazard ratio = 2.76, 95% confidence interval: 1.35, 5.67). A significant interactive effect on lung cancer risk between hyperkeratosis and cigarette smoking was identified, which suggests that patients with hyperkeratosis who have been exposed to arsenic should cease smoking.