A Negro brother and sister are described in whom generalized mottled depigmentation ("raindrops in the dust") had been present for many years. The brother also had syndactylism and a flexural contracture of the hands. The sister had some palmar changes as well as esophageal stenosis. The subsequent development of a squamous cell epithelioma in the brother and Bowen's cell carcinoma in the sister suggests that the dyschromia could reflect either occult arsenic intake or a genetic defect. In either instance this pigmentary change may serve as another prodromal sign for malignancy.
Cornelius CE, Shelley WB. Syndactylism, Dyschromia, and the Arsenical Dilemma. Arch Dermatol. 1968;98(2):107-110. doi:10.1001/archderm.1968.01610140005001