砒素癌の1例

ARSENICAL CARCINOMA OF THE SKIN

I．はじめに

　1887年Hutchinsonが皮膚癌の原因因子として砒素の役割に注目して以来，欧米では砒素癌の報告は多く，Neubauer^1）は1947年までの医薬品による143例，職業的接触による24例を集録している。一方本邦では砒素癌の報告はまれで，この点は第64回日本皮膚科学会総会シンポジウムでも注目きれている^2）〜5）。最近我々は精米に使用するつき粉と誤つて砒素剤が混入した米を長期間とり，中毒症状を示した患者に発生した砒素癌の1例を経験したので報告する。

　The patient was a 44-year-old male farmer. About 17 years ago he was afflicted with exfoliative dermatitis after taking rice for a period of 6 months which had been contaminated by an arsenic compound during rice-processing operations. One year after that, generalized melanoderma and 13 years later keratosis and bowenoid lesions developed. Some of the lesions became tumorous during the course of a year. Among 17 family members who took the rice from the same source, 7 including the patient have shown the signs of chronic arsenism. The father of the patient had had the finger amputated because of squamous cell carcinoma.

　The cutaneous lesions of the patient consisted of melanoderma, multiple keratotic papules on the extremities, bowenoid lesions on the trunk and extremities, and vegetating or ulcerated tumors on the thighs, the inguinal regions, and the sole of the right foot. No bowenoid lesions were seen on ,he palms and soles. Histology : In more than half of the lesions which were clinically diagnosed as arsenical keratosis, atypical cells were found in the prickle cell layer and no sharp distinction could be made between keratosis and Bowen's disease. In tumors which were mostly of the squamous cell type, bowenoid features were prominent. Two of the inguinal lymph nodes contained metastatic squamous cell carcinoma. The patient was treated with surgical excision of the tumors, radiotherapy, and injections of cyclophosphamide and BAL. He is now in good condition 3 years and 8 months after the first consultation and has no signs and symptoms of cutaneous or internal malignancies.