| A Case of Bowen's Disease and Small-Cell Lung Carcinoma: Long-Term Consequences of Chronic Arsenic Exposure in Chinese Traditional Medicine Linda Lee1 and Gwyn Bebb2 1University of Alberta, Faculty of Medicine, Edmonton, Alberta, Canada; 2Tom Baker Cancer Centre, Calgary, Alberta, Canada Abstract
 | The University of Alberta and |  | The Tom Baker Cancer Center |
Chronic arsenic toxicity occurs primarily through inadvertent ingestion of contaminated water and food or occupational exposure, but it can also occur through medicinal ingestion. This case features a 53-year-old lifetime nonsmoker with chronic asthma treated for 10 years in childhood with Chinese traditional medicine containing arsenic. The patient was diagnosed with Bowen's disease and developed extensive-stage small-cell carcinoma of the lung 10 years and 47 years, respectively, after the onset of arsenic exposure. Although it has a long history as a medicinal agent, arsenic is a carcinogen associated with many malignancies including those of skin and lung. It is more commonly associated with non-small-cell lung cancer, but the temporal association with Bowen's disease in the absence of other chemical or occupational exposure strongly points to a causal role for arsenic in this case of small-cell lung cancer. Individuals with documented arsenic-induced Bowen's disease should be considered for more aggressive screening for long-term complications, especially the development of subsequent malignancies. Key words: arsenic, Bowen's disease, case report, Chinese traditional medicine, chronic toxicity, small-cell lung carcinoma. Environ Health Perspect 113:207-210 (2005) . doi:10.1289/ehp.7200 available via http://dx.doi.org/ [Online 20 December 2004]
Address correspondence to G. Bebb, Tom Baker Cancer Centre, 1331, 29th St. NW, Calgary, Ab, T2N 4N2, Canada. E-mail: gwynbebb@cancerboard.ab.ca We thank K. Smith for photographing the skin lesions and B. Sheehan and N. Murray for reviewing the manuscript. The authors declare they have no competing financial interests. Received 22 April 2004 ; accepted 20 December 2004.
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