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September 1975

Spiny Palmar Keratosis

Arch Dermatol. 1975;111(9):1214. doi:10.1001/archderm.1975.01630210130022

To the Editor.—  Dobson et al1 wrote of an increased incidence of palmar keratoses in patients with various internal malignant diseases. This finding was disputed by Bean et al,2 who suggest that exposure to the carcinogenic effects of arsenicals could possibly explain the coincidence. The hyperkeratosis these authors describe is in the form of flat or rounded papules on the palms, especially involving the thenar and hypothenar eminences.3 We have recently seen a patient with unusual keratotic lesions who also had malignant carcinoma.

Report of a Case.—  A 65-year-old woman was receiving therapy for an advanced bronchogenic carcinoma that had been diagnosed seven months earlier. Six weeks before examination, she noted the development of small "spines" on her hands that were annoying but were otherwise asymptomatic. She had no history of psoriasis, Darier disease, or other skin disease, and denied exposure to arsenicals. The patient had had

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