RESUMO
A 53-year-old Korean woman with known history of psoriasis and treatment with ustekinumab over 16 months, presented with a nontender erythematous plaque with oozing noted on her left sole. Histopathologic examination of the lesion confirmed squamous cell carcinoma (SCC). Although use of ustekinumab was considered a possible risk factor for the development of SCC, administration of ustekinumab was continued per her request following an operation for removal of the SCC. And 19 months later, newly developed multiple hyperkeratotic papules on her soles were diagnosed as arsenic keratosis based on her past history of consumption of Chinese traditional herbal medicine. I concluded that SCC in this patient was not caused by ustekinumab, but was associated with arsenic keratosis. This case emphasizes that screening for risk factors associated with skin malignancies, such as exposure to arsenic or presence of arsenic keratosis, should be performed prior to using biologics in Korean psoriasis patients.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Arsênio , Povo Asiático , Produtos Biológicos , Carcinoma de Células Escamosas , Células Epiteliais , Medicina Herbária , Ceratose , Programas de Rastreamento , Psoríase , Fatores de Risco , Pele , UstekinumabRESUMO
Arsenic keratosis can be a precursor of both Bowen's disease and squamous cell carcinoma. In fact, there is a direct dose-response relationship between the amount of arsenic exposure and the development of skin cancer. Therefore, meticulous dermatologic surveillance and follow-up are advised to detect malignancy at an early and curable stage. We herein report on a case of a 62-year-old man who presented with multiple Bowen's disease and arsenic keratosis. His past history revealed chronic exposure to arsenic through consumption of Chinese traditional herbal medicine. After a follow-up loss of 2 years, he returned with multiple extracutaneous metastases of squamous cell carcinoma, including the liver. Our case emphasizes the importance of regular follow-up and survey for skin cancer and other internal malignancies in patients with history of chronic arsenic exposure.