Arsenical Keratoses and Non-Hodgkin's Lymphoma: Arsenic

Total Page:16

File Type:pdf, Size:1020Kb

Arsenical Keratoses and Non-Hodgkin's Lymphoma: Arsenic Journal of Pakistan Association of Dermatologists 2012; 22 (4):366-369. Case Report Arsenical keratoses and non-Hodgkin’s lymphoma: arsenic-induced or coincidental conditions? Kiymet Handan Kelekci*, İlgül Bilgin*, Murat Ermete ** *Ministry of Health, İzmir Atatürk Education and Research Hospital, Dermatology Clinic, İzmir, Turkey **Ministry of Health, İzmir Atatürk Education and Research Hospital, Pathology Clinic, İzmir, Turkey Abstract Arsenic, a naturally occurring metal, is best known as a poison and can generate both acute and chronic toxicity. Exposure can occur through air, water, soil, and food. Chronic arsenic toxicity is usually asymptomatic and the first sign may be cutaneous findings. Arsenic keratosis is a precancerous lesion related to chronic arsenism. Non-Hodgkin’s lymphoma (NHL) is a T or B cell malignancy usually originating from lymph nodes and fewer in every other organ.We report a concomitant occurrence of arsenic keratosis and NHL in a Caucasian man.To our knowledge, this is the first such reported case. Key words Arsenic, arsenical keratoses, non-Hodgkin’s lymphoma. Introduction raindrop.2 Neurologic effects, pregnancy and delivery problems of pregnant women, Inorganic arsenic, a human carcinogen, is hypertension, diabetes mellitus, respiratory ubiquitous in the environment.1 The symptoms disorders, cardiovascular problems, cirrhosis, of chronic arsenic poisoning may appear due to lung cancer, cutaneous cancers, urinary system arsenic exposure from environmental, cancers, hepatic angiosarcoma, leukemia, and occupational and nutrition habits. Chronic lymphoma may occur.1,3,5 arsenic toxicity is usually asymptomatic and the first sign may be cutaneous findings. Non-Hodgkin’s lymphoma (NHL) is a T or B Arsenic keratosis is a precancerous lesion cell malignancy usually originating from related to chronic arsenism. 1,2 It is lymph nodes and fewer in every other organ. characterized by 2-10 mm keratotic palpable NHL is more prevalent in cases of immune papules settled on the palmar and plantar suppressive conditions such as viral infections region, lateral and dorsalis of fingers.1-4 The (HTLV-1, EBV, HHV8, HCV, and AIDS) and other cutaneous findings of chronic arsenism drug usage (TNF-alfa inhibitors, are hyperpigmentation on nipples, axilla, groin chemotherapy) and in dye and metal industry and compression sites of the body and diffuse workers and occupations that involve alopecia. The hypopigmentation on a pesticides.5-8 We report a concomitant hyperpigmentation region is shaped like a occurrence of arsenic keratosis and NHL in a Caucasian man. To our knowledge, this is the Address for correspondence first reported case of NHL such an occurrence Kiymet Handan Kelekci Korutürk Mah. in arsenic keratosis. Kasırga Sok. Özyıldırım sitesi No:21/1 D:3 Balçova / İzmir Phone:090 232 244 4444 E-mail:[email protected] 366 Journal of Pakistan Association of Dermatologists 2012; 22 (4):366-369. Case report A 61-year-old patient was admitted to the outpatient clinic complaining of dry skin on his face, hands and legs for three months. He had worked in the metal industry for 40 years and had retired five years ago. He was a pack a day smoker for 31 years. Stage II bulky CD30+ anaplastic large cell NHL had been diagnosed with biopsy of left axillary mass five months ago. Figure 1 2-6 mm wide white keratotic papules and xerotic appearance on both hands and forearm. Dermatologic examination revealed white keratotic papules 2-6mm in diameter on dorsalis of both feet and legs and hand and arms; guttate hypopigmentation on hyperpigmentation area of back; 5x5 in diameter mass in axilla with peripheral erythema; and xerotic view of face and extremities ( Figure 1 and 2). Routine biochemistry and urinalysis were normal. Radiologic examination was normal. The patient did not consent to measure arsenic levels in his hair and nails. Anti- Figure 2 Multiple nodules, 5x5 cm, (stage IIB cytomegalovirus IgG, Epstein-Barr virus bulky CD 30(+) anaplastic large cell NHL) and nonblanchable erythema. (EBV) VCA IgG and EBV EBNA IgG were positive. A skin biopsy taken from the dorsal side of the hand revealed hyperkeratosis, mild papillomatosis, mild atypical epidermal cells throughout basement membrane, normal papillary of dermis, all compatible with arsenic keratosis ( Figure 3). The cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) protocol was administered by the hematology department. Arsenical keratoses of arms, dorsal sides of hands and feet were treated by topical Figure 3 Hyperkeratosis, mild papillomatosis, epidermis with mild atypia throughout basement retinoic acid. layer and normal dermis (H&E). Discussion Epidemiologic studies point that arsenic toxicity is a major health problem in some Arsenic, a naturally occurring metal, is best regions of the world characterized by high known as a poison and can generate both acute arsenic content (>50µg/L) such as Argentina, and chronic toxicity. Exposure can occur Taiwan and Bangladesh.1,2 through air, water, soil, and food. 367 Journal of Pakistan Association of Dermatologists 2012; 22 (4):366-369. Arsenic tends to concentrate in ectodermal prevalence of malignancy such as lung, renal, tissues, including the skin, hair, and nails, even hepatic cancer and NHL increased in Ihado, by at low-level exposures. Thus, the skin is a drinking water that contained high levels of primary target organ for chronic arsenic arsenic (2-10µg/L), but when taken into toxicity. The skin is very sensitive to arsenic account confounding factors such as smoking, and skin lesions are, therefore, the most gender, body mass index (BMI) in the common and earliest non-malignant population studied, there was no significant manifestation of chronic arsenism. 5 relationship between malignancy and arsenic. Hypomelanotic guttate macules on diffuse In our country, the arsenic content of well hyperpigmentation and arsenical keratosis may water is higher, especially in rural areas. be formed. These hypomelanotic guttate Marshall pointed out in a retrospective study macules on diffuse hyperpigmentation that mortality from lung and bladder cancers resemble ''raindrops on a dusty road''.3 Our increased in some regions of Chile where case had typical cutaneous presentation of drinking water contained high levels of chronic arsenic toxicity. Manifestations of arsenic.12 Lee et al .10 reported a case where chronic arsenicosis may appear after latent Bowen disease and small cell lung cancer were period between six months and 50 years or diagnosed as a cause of treatment with herbal more.3,4,10 Bowen disease and squamous cell medicine, which contained high levels of carcinoma may develop under arsenical arsenic. In another study, it was reported that keratosis.1,2,5 Diagnosis of arsenic intoxication the prevalence of lung, liver and bladder is often difficult because clinical presentation cancers doubled in Bangladesh, where there is varies depending on route of exposure, high content of arsenic in fresh water.13 In our chemical form, dose, and time elapsed since case, there were both pigmentary changes and exposure. It can be difficult to elicit a clear keratoses associated with arsenic on skin and history of exposure either to contaminated food NHL. However, cancers may be triggered by or well water, or through occupational various causative factors. Examination of the exposure. Furthermore, because arsenic affects arsenic content of drinking water may be of multiple systems, poisoning can present with a limited value.10 wide variety of signs and symptoms.10 Fritschi et al .8 performed a study to determine Arsenic may cause impaired nucleotide repair the relationship between NHL and with DNA mutations. Cells rich in keratin such occupational risk factors because of the as epidermal keratinocyte are subject to arsenic increased prevalence of NHL in Australia toxicity. Arsenic may cause keratinocyte during the last decade. They found that proliferation and differentiation by raised exposure to hydrocarbons with aromatic growth factors. However, it is not completely chlorine except benzene, aliphatic solvent and understood how arsenic compounds might firewood powder may cause NHL. Skoy et al .9 cause carcinogenic process.4,5,10 found that NHL was more common in workers of metal industry and welders in Denmark. The World Health Organization (WHO) has According to WHO, pigmentation or keratosis, stated precisely that the upper allowable limit both cutaneous lesions are necessary to of arsenic in drinking water is %0.01µg/L. diagnose arsenism. 14 In another study, it was Therefore, chronic exposure more than found that arsenic toxicity might increase the allowable upper limits may cause benign skin risk of visceral malignancy among metal changes, cutaneous malignancy and visceral workers.7 Cases of occupational origin are malignancy. 2 Han et al .11 revealed that the most commonly caused by metal arsenic 368 Journal of Pakistan Association of Dermatologists 2012; 22 (4):366-369. trioxide used as insecticide, copper cancers. J Cutan Pathol 2007; 34 :203-6. acetoarsenite, lead arsenate, and calcium 3. Smith M. Environmental and sports- related skin disease. In: Bolognia JL, arsenate used as insecticides or copper arsenite Rapini RP, eds. Dermatology . used as a pigment in wallpapers and paints Philadelphia: Mosby; 2007. P. 1396-99. manufacturing. Other possible sources are 4. Chen J C-S. Arsenical keratosis. Medscape dermatology, e-medicine 24 mart, 2008. cigarette smoke, city smoke and pesticides. In 5. Centeno
Recommended publications
  • Arsenicosis Presenting with Cutaneous Squamous Cell Carcinoma: a Case Report
    CASE REPORT Arsenicosis Presenting with Cutaneous Squamous Cell Carcinoma: A Case Report Marie Len A. Camaclang,1 Eileen Liesl A. Cubillan2 and Claudine Yap-Silva2 1Section of Dermatology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila 2Section of Dermatology, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila ABSTRACT A 29-year-old male with eleven-year history of hyperkeratotic papules and speckled pigmentation developed cutaneous squamous cell carcinoma. Arsenicosis was confirmed by elevated hair arsenic level, and histopathologic findings of arsenical keratosis and one lesion showing carcinoma-in-situ. Chronic arsenic exposure has been found to activate inflammatory and carcinogenic pathways leading to development of pre-malignant and malignant lesions. A multi-disciplinary approach involving healthcare specialists and environmentalists is crucial in source control and management of long-term complications. Key Words: arsenic, arsenic poisoning, arsenicosis, skin cancer, squamous cell carcinoma INTRODUCTION Arsenic is a potential human carcinogen of public health concern. Exposure may be via inhalation of arsenic dusts, direct contact with arsenites, or ingestion of contaminated water, the latter being the most common route.1 Chemical contamination of groundwater may come from natural sources such as geochemical processes (e.g. volcanic activities), as well as the result of human activities including mining wastes, landfills,
    [Show full text]
  • Arsenic-Induced Lesions
    33 As75 Arsenic-Induced Lesions Prepared By: José A. Centeno, Ph.D.1 Leonor Martínez, M.D.1 Elena R. Ladich, M.D.1 Norbert P. Page, D.V.M., M.S.1 Florabel G. Mullick, M.D., SES1 Kamal G. Ishak, M.D., Ph.D.1 Baoshan Zheng, Ph.D.5 Herman Gibb, Ph.D.2 Claudia Thompson, Ph.D.3 David Longfellow, Ph.D.4 Sponsored By: 1Armed Forces Institute of Pathology American Registry of Pathology 2U.S. Environmental Protection Agency 3National Institute of Environmental Health Sciences 4National Cancer Institute U.S. Geological Service Contributor: 5Institute of Geochemistry & Academia Sinica, P.R. China April 2000 ISBN: 1-881041-68-9 Armed Forces Institute of Pathology American Registry of Pathology Washington, DC 2000 Available from American Registry of Pathology Bookstore Web site at www.afip.org 4 Preface The public health concern for environmental exposure to arsenic 35 ( As75) has been widely recognized for decades. However, recent human activities have resulted in even greater arsenic exposures and the potential increase for chronic arsenic poisoning on a worldwide basis. This is especially the case in China, Taiwan, Thailand, Mexico, Chile, and India. The sources of arsenic expo- José A. Centeno, Ph.D. sure vary from burning of arsenic-rich coal (China) and mining activities (Malaysia, Japan) to the ingestion of arsenic-contami- nated drinking water (Taiwan, Philippines, Mexico, Chile). The groundwater arsenic contamination in Bangladesh and the West Bengal Delta of India has received the greatest international attention due to the large number of people potentially exposed and the high prevalence of arsenic-induced diseases.
    [Show full text]
  • Thymoquinone Induces Apoptosis and DNA Damage in 5-Fluorouracil-Resistant Colorectal Cancer Stem/Progenitor Cells
    www.oncotarget.com Oncotarget, 2020, Vol. 11, (No. 31), pp: 2959-2972 Research Paper Thymoquinone induces apoptosis and DNA damage in 5-Fluorouracil-resistant colorectal cancer stem/progenitor cells Farah Ballout1, Alissar Monzer1, Maamoun Fatfat1, Hala El Ouweini1, Miran A. Jaffa2, Rana Abdel-Samad3, Nadine Darwiche3, Wassim Abou-Kheir4 and Hala Gali-Muhtasib1,4 1Department of Biology, American University of Beirut, Lebanon 2Department of Epidemiology and Population Health, American University of Beirut, Lebanon 3Department of Biochemistry and Molecular Genetics, American University of Beirut, Lebanon 4Center for Drug Discovery and Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Lebanon Correspondence to: Hala Gali-Muhtasib, email: [email protected] Wassim Abou-Kheir, email: [email protected] Keywords: thymoquinone; colorectal cancer stem cells; 5-Fluorouracil resistance; colonospheres; apoptosis Received: October 08, 2019 Accepted: December 16, 2019 Published: August 04, 2020 Copyright: Ballout et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License 3.0 (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. ABSTRACT The high recurrence rates of colorectal cancer have been associated with a small population of cancer stem cells (CSCs) that are resistant to the standard chemotherapeutic drug, 5-fluorouracil (5FU). Thymoquinone (TQ) has shown promising antitumor properties on numerous cancer systems both in vitro and in vivo; however, its effect on colorectal CSCs is poorly established. Here, we investigated TQ’s potential to target CSCs in a three-dimensional (3D) sphere-formation assay enriched for a population of colorectal cancer stem/progenitor cells.
    [Show full text]
  • Randomized Double-Blind Trial to Evaluate the Effectiveness of Topical Administration of Propylene Glycol in Arsenical Palmer Keratosis
    A Journal of the Bangladesh Pharmacological Society (BDPS) Bangladesh J Pharmacol 2010; 5: 98-102 Journal homepage: www.banglajol.info Abstracted/indexed in Academic Search Complete, Agroforestry Abstracts, Asia Journals Online, Bangladesh Journals Online, Biological Abstracts, BIOSIS Previews, CAB Abstracts, Current Abstracts, Directory of Open Access Journals, EMBASE/Excerpta Medica, Google Scholar, HINARI (WHO), International Pharmaceutical Abstracts, Open J-gate, Science Citation Index Expanded, SCOPUS and Social Sciences Citation Index ISSN: 1991-0088 Randomized double-blind trial to evaluate the effectiveness of topical administration of propylene glycol in arsenical palmer keratosis Ashrafun Naher Dina and Mir Misbahuddin Division of Arsenic Research, Department of Pharmacology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh. Article Info Abstract Received: 20 April 2011 Keratosis, one of the earliest skin manifestations of arsenicosis, can be treated Accepted: 22 April 2011 by either oral or topical formulation of drug. In this study, we examined the Available Online: 27 April 2011 effectiveness and tolerance of propylene glycol for the treatment of arsenical DOI: 10.3329/bjp.v5i2.7527 palmer keratosis. Sixty patients of arsenicosis with palmer keratoses were randomly divided into three groups and different concentrations (15, 30 and 45%) of propylene glycol were applied topically into their palms once at bedtime for eight weeks. The perception of the patient about the progress of treatment was scored with "Likert scale". The mean (± SD) score of patient's perception following completion of treatment were 1.3 ± 1.3 (using 15% propylene glycol), 2.9 ± 1.3 (30% propylene glycol), and 3.8 ± 1.1 (45% Cite this article: propylene glycol) respectively.
    [Show full text]
  • A Deep Learning System for Differential Diagnosis of Skin Diseases
    A deep learning system for differential diagnosis of skin diseases 1 1 1 1 1 1,2 † Yuan Liu ,​ Ayush Jain ,​ Clara Eng ,​ David H. Way ,​ Kang Lee ,​ Peggy Bui ,​ Kimberly Kanada ,​ ​ ​ ‡ ​ 1​ ​ 1 ​ 1 ​ Guilherme de Oliveira Marinho ,​ Jessica Gallegos ,​ Sara Gabriele ,​ Vishakha Gupta ,​ Nalini 1,3,§ 1 ​ ​ 4 ​ 1 ​ ​ 1 Singh ,​ Vivek Natarajan ,​ Rainer Hofmann-Wellenhof ,​ Greg S. Corrado ,​ Lily H. Peng ,​ Dale ​ ​ 1 1 ​ † 1, ​ 1, ​ 1, ​ R. Webster ,​ Dennis Ai ,​ Susan Huang ,​ Yun Liu *​ , R. Carter Dunn *​ *, David Coz *​ * ​ ​ ​ ​ ​ ​ Affiliations: 1 G​ oogle Health, Palo Alto, CA, USA 2 U​ niversity of California, San Francisco, CA, USA 3 M​ assachusetts Institute of Technology, Cambridge, MA, USA 4 M​ edical University of Graz, Graz, Austria † W​ ork done at Google Health via Advanced Clinical. ‡ W​ ork done at Google Health via Adecco Staffing. § W​ ork done at Google Health. *Corresponding author: [email protected] **These authors contributed equally to this work. Abstract Skin and subcutaneous conditions affect an estimated 1.9 billion people at any given time and remain the fourth leading cause of non-fatal disease burden worldwide. Access to dermatology care is limited due to a shortage of dermatologists, causing long wait times and leading patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in over- and ​ ​ ​ ​ ​ ​ ​ under-referrals, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories).
    [Show full text]
  • American Osteopathic College of Dermatology PRSRT STD Olume 3700 North 32Nd Terrace U.S
    V Journal of the American Osteopathic College of Dermatology PRSRT STD OLUME 3700 North 32nd Terrace U.S. POSTAGE Journal of the PAID Hollywood, Fl 33201 MASON CITY, IA N 8, PERMIT NO. 429 UMBER Address Correction Requested 2 American Osteopathic College of Dermatology J OUR N AL OF THE A MERICA N O STEOPATHIC C OLLEGE OF D ERMATOLOGY O CTOBER 2007 SPONSORS: GLOBAL PATHOLOGY LABORATORY • STIEFEL LABORATORIES ALLERGAN SKIN CARE • MEDICIS Journal of the American Osteopathic College of Dermatology 2007-2008 Officers President: Jay S. Gottlieb, D.O. President Elect: Donald K. Tillman, D.O. Journal of the First Vice-President: Marc I. Epstein, D.O. Second Vice-President: Leslie Kramer, D.O. Third Vice-President: Bradley P. Glick, D.O. American Immediate Past-President: Bill V Way, D.O. Trustees: Karen Neubauer, D.O. James B. Towry, D.O. Osteopathic Mark Kuriata, D.O. David Grice, D.O. College of Executive Director: Rebecca Mansfield, M.A. Dermatology Sponsors: Editors Global Pathology Laboratory JAOCD Jay S. Gottlieb, D.O., F.O.C.O.O. Founding Sponsor Stanley E. Skopit, D.O., F.A.O.C.D. Stiefel Laboratories James Q. Del Rosso, D.O., F.A.O.C.D. Allergan Skin Care JAOCD Founding Sponsor Medicis JAOCD Founding Sponsor Editorial Review Board Ronald Miller, D.O. JAOCD Eugene Conte, D.O. Founding Sponsor Evangelos Poulos, M.D. AOCD • 1501 E. Illinois • Kirksville, MO 63501 800-449-2623 • FAX: 660-627-2623 Stephen Purcell, D.O. www.aocd.org Darrel Rigel, M.D. Robert Schwarze, D.O. COPYRIGHT AND PERMISSION: written permission must be obtained from the Journal of the American Osteopathic Andrew Hanly, M.D.
    [Show full text]
  • Cultural Dermatoses: a Review
    Volume 41 November 2018 JAOCD Journal Of The American Osteopathic College Of Dermatology The Final Issue AsCultural dermatologists seeDermatoses: a shift toward a minority patientA Review base, recognizing dermatoses linked to non-U.S. cultural practices will be invaluable. Also in this Issue: A New Trigger of Morbilliform Eruption Vitiligo-like Hypopigmentation with Topical Imiquimod An Unusual Presentation of Pachydermodactyly JOURNAL OF THE AMERICAN OSTEOPATHIC COLLEGE OF DERMATOLOGY 2018-2019 AOCD OFFICERS PRESIDENT Daniel Ladd, DO, FAOCD PRESIDENT-ELECT John P. Minni, DO, FAOCD FIRST VICE-PRESIDENT Reagan Anderson, DO, FAOCD SECOND VICE-PRESIDENT David Cleaver, DO, FAOCD Editor-in-Chief THIRD VICE-PRESIDENT Amy Spizuoco, DO, FAOCD Karthik Krishnamurthy, DO SECRETARY-TREASURER Steven Grekin, DO, FAOCD Assistant Editor Julia Layton, MFA TRUSTEES Danica Alexander, DO, FAOCD (2016-2019) Peter Saitta, DO, FAOCD (2016-2019) Jonathan Crane, DO, FAOCD (2017-2020) Michael Whitworth, DO, FAOCD (2017-2020) Steven Brooks, DO, FAOCD (2018-2021) Jerome Obed, DO, FAOCD (2018-2021) IMMEDIATE PAST-PRESIDENT Karthik Krishnamurthy, DO, FAOCD EXECUTIVE DIRECTOR Marsha A. Wise, BS AOCD • 2902 N. Baltimore St. • Kirksville, MO 63501 800-449-2623 • FAX: 660-627-2623 • www.aocd.org COPYRIGHT AND PERMISSION: Written permission must be obtained from the Journal of the American Osteopathic College of Dermatology for copying or reprinting text of more than half a page, tables or figures. Permissions are normally granted contingent upon similar permission from the author(s), inclusion of acknowledgement of the original source, and a payment of $15 per page, table or figure of reproduced material. Permission fees are waived for authors wishing to reproduce their own articles.
    [Show full text]
  • Arsenic Toxicity CSEM Are Available
    Arsenic Toxicity Cover Page Course: WB 1576 CE Original Date: October 1, 2009 CE Renewal Date: October 1, 2011 CE Expiration Date: October 1, 2013 Key Concepts • Prolonged arsenic exposure causes skin and lung cancer and may cause other internal cancers as well. • Skin lesions, peripheral neuropathy, and anemia are hallmarks of chronic arsenic exposure. About This and Other This educational case study document is one in a series of Case Studies in self-instructional modules designed to increase the primary Environmental care provider’s knowledge of hazardous substances in the Medicine environment and to promote the adoption of medical practices that aid in the evaluation and care of potentially exposed patients. The complete series of Case Studies in Environmental Medicine is located on the ATSDR Web site at URL: http://www.atsdr.cdc.gov/csem/csem.html. In addition, the downloadable PDF] version of this educational series and other environmental medicine materials provides content in an electronic, printable format, especially for those who may lack adequate Internet service. How to Apply for and See Internet address http://www2.cdc.gov/atsdrce/ for more Receive Continuing information about continuing medical education credits, Education Credit continuing nursing education credits, and other continuing education units. Acknowledgements We gratefully acknowledge the work that the medical writers, editors, and reviewers have provided to produce this educational resource. Listed below are those who have contributed to development of this version of the Case Study in Environmental Medicine. Please Note: Each content expert for this case study has indicated that there is no conflict of interest to disclose that would bias the case study content.
    [Show full text]
  • Medicare Part B.- Medical Policy Procedures-Benign Or Premalignant Skin Lesion Removal/Destruction
    Medicare Part B Medical Policy Procedures ✓--· ··, ! ) BENIGN OR PREMALIGNANT SKIN LESION REMOVAUDESTRUCTION G0051 Description Benign or premalignant skin lesion removal/destruction Policy Type Local medical necessity policy Indications and Limitations of Coverage and/or Medical Necessity Medicare 8 will consider the destruction of a benign or premalignant skin lesion medically necessary under the following circumstances: • When the patient presents with an actinic keratosis that has changed in size, has developed erythema, has thickened, has ulcerated, has eroded, has developed changes at the tumor margins, has become markedly hyperkeratotic, in which pain has developed and/or a cutaneous horn has developed; • When the patient presents with an actinic keratosis on the nose, ear, or eyelids; • When the patient presents with a actinic keratosis and has a history of one of the following: - chronic immunosuppression such as that associated with organ transplantation, particularly renal transplantation, and other disease processes such as Human Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) and/or chronic lymphocytic leukemia or lymphoma; - treatment of psoriasis with psolaren-ultraviolet A (PUVA) therapy; - xeroderma pigmentosum, albinism, or discoid lupus erythematosus; and/or, previous treatment of a biopsy-proven Squamous Cell Carcinoma (SCC) or other skin malignancy. • When the patient has multiple actinic keratoses and has self-administered 2% to 5% Fluorouracil (Efudex) topical cream for two to four weeks and the actinic keratoses have not responded to this treatment one to two months following treatment*, or * It should be noted that the natural response to fluorouracil (Efudex) is erythema, usually . / followed by vesiculation, desquamation, erosion and reepithelialization. Therefore, during and immediately following fluorouracil treatment these signs and symptoms would be considered part of the response/healing process and would not be considered as meeting the criteria for removal.
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2005/0214328A1 Zeldis Et Al
    US 2005O214328A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2005/0214328A1 Zeldis et al. (43) Pub. Date: Sep. 29, 2005 (54) METHODS OF USING AND COMPOSITIONS Publication Classification COMPRISING IMMUNOMODULATORY COMPOUNDS FOR THE TREATMENT AND (51) Int. Cl." ......................... A61K 39/08; A61K 38/21; MANAGEMENT OF SKIN DISEASES OR A61K 35/78; A61K 31/19; DSORDERS A61K 31/59 (52) U.S. Cl. ..................... 424/239.1; 424/769; 424/85.4; 514/159; 514/557; 514/559; (76) Inventors: Jerome B. Zeldis, Princeton, NJ (US); 514/12: 514/588 Robert J. Hariri, Florham Park, NJ (57) ABSTRACT (US) Methods of treating, preventing, correcting and/or managing Correspondence Address: skin diseases or disorders characterized by Overgrowths of JONES DAY the epidermis, keratoses, Scleroderma, cutaneous vasculitis, 222 EAST 41ST ST acne or wrinkles are disclosed. Specific embodiments NEW YORK, NY 10017 (US) encompass the administration of an immunomodulatory compound, or a pharmaceutically acceptable Salt, Solvate, (21) Appl. No.: 11/085,905 hydrate, Stereoisomer, clathrate, or prodrug thereof, alone or in combination with a Second active agent. Specific Second (22) Filed: Mar. 22, 2005 active ingredients are capable of affecting or inhibiting cell Related U.S. Application Data growth or proliferation, removing or improving acne Scars, or reducing or correcting wrinkle lines. Pharmaceutical (60) Provisional application No. 60/554,923, filed on Mar. compositions, Single unit dosage forms, and kits Suitable for 22, 2004. use in methods of the invention are also disclosed. Patent Applicat US 2005/0214328A1 US 2005/0214328A1 Sep. 29, 2005 METHODS OF USING AND COMPOSITIONS actinic keratoses has been reported in fair, redheaded, and COMPRISING IMMUNOMODULATORY blonde patients who burn frequently and tan poorly.
    [Show full text]
  • A Case of Arsenical Keratoses After Chronic Consumption of Water from Tube Wells Sealtiel Adrian Tinajero, DO,* Howard Camille, DO,** Suzanne Rozenberg, DO***
    A Case of Arsenical Keratoses After Chronic Consumption of Water from Tube Wells Sealtiel Adrian Tinajero, DO,* Howard Camille, DO,** Suzanne Rozenberg, DO*** *2nd-year Resident, Dermatology Residency Program, St. John’s Episcopal Hospital, Far Rockaway, NY **1st-year Resident, Dermatology Residency Program, St. John’s Episcopal Hospital, Far Rockaway, NY ***Program Director, Dermatology Residency Program, St. John’s Episcopal Hospital, Far Rockaway, NY Disclosures: None Correspondence: Sealtiel Adrian Tinajero, DO; [email protected] Abstract Arsenic has been shown to increase the risk of developing skin cancers, including basal cell carcinoma and squamous cell carcinoma. A 44-year-old male from Bangladesh presented to the clinic for evaluation and treatment of scaly plaques on his palms and soles, and skin biopsy showed arsenical keratosis. The World Health Organization defines the maximum amount of arsenic allowed in drinking water as 0.01 mg/L, but testing of tube wells in Bangladesh found that up to 30% had levels exceeding 0.05 mg/L. This represents approximately 36 million people at risk of drinking water with unsafe levels of arsenic. This case highlights the importance of being aware of this rare presentation, as early treatment and close monitoring is key to preventing cutaneous malignancies. Case Report in Bangladesh showed that up to 30% of tube A 44-year-old male presented to the clinic for wells had levels exceeding 0.05 mg/L, representing approximately 36 million people drinking water evaluation and treatment of scaly plaques on his 2 palms and soles. On physical exam, there were with unsafe levels of arsenic.
    [Show full text]
  • Squamous Cell Carcinoma Secondary to Arsenic Keratoses in a Father And
    Squamous cell carcinoma secondary to arsenic keratoses in a father and son Jennifer Aileen Ang-Tangtatco, MD, DPDSa; Karen Lee Alabado, MD, FPDSb; Lalaine Visitacion, MD, FPDSb Arsenic is categorized as a class I human carcinogen by the International Agency for Research on Cancer and chronic exposure to its inorganic form have been associated with a variety of diseases. Its effect on the skin is the most sensitive endpoint of arsenic exposure and dermal manifestations include arsenic keratoses, a premalignant lesion and considered a diagnostic criterion of arsenic toxicity. We report two cases of chronic arsenic poisoning in a father and son who presented with a history of hypo- and hyperpigmented macules and patches over the body and multiple hyperkeratotic papules over the palms and soles, progressing to ulceration. All other family members, except for one, also had the pigmentary changes on the body and palmoplantar hyperkeratosis. Histopathology results of the ulcerated lesions of both patients were consistent with squamous cell carcinoma. Surgical interventions, oral retinoids, and nutritional buildup were done. The patients are being followed up every six months to monitor cancer progression and internal organ involvement. These cases highlight the role of occupational and environmental exposure to arsenic as an important risk factor in developing keratoses and cancer. Department of Dermatology, Southern Philippines Medical Center, Davao City, Keywords: arsenic, arsenic keratoses, squamous cell carcinoma a b Davao del Sur, Philippines Resident Graduate Consultant Source of funding: none Conflict of interest: none INTRODUCTION Corresponding author: Jennifer Aileen A. Tangtatco, MD Email: [email protected] 9 rsenecosis is a condition arising from prolonged extremities.
    [Show full text]