Recurrent arsenic induced cancers over 20 years: a surgeon's nightmare!

Arsenic poisoning is a common community health problem plaguing India as well as many other countries worldwide. In India West Bengal, Bihar, Chhattisgarh, Jharkhand, Assam and Manipurhas been the worst sufferers. The ill effects of arsenic is well known to the medical community which primarily can be categorized into nonmalignant and malignant manifestations. The former category includes a wide range of symptoms ranging from generalized weakness, anaemia, fatigue to neurotoxicity, hepatotoxicity or chronic gastrointestinal diseases. Out of all malignancies skin cancer is the commonest and deserves attention. These cancers are often multiple, indolent and often occur after a median latency of two decades. Given their tendency to recur even after wide resection and predilection to affect multiple body parts at the same time, re resection becomes challenging and cosmetically demanding. Treatment of such patients may require multiple surgical interventions and require close surveillance to detect internal cancers, local recurrences or new primaries at the earliest.