LAUSR

An 83yearold woman of European ancestry had an initial diagnostic consideration of arsenical keratosis in 2014 on the presumed background of childhood arsenic exposure reportedly from a cough mixture containing arsenic flakes. She disclosed smoking an average of ten cigarettes per day since she was 14 years old and reported a history of chronic obstructive pulmonary disease and dyslipidaemia, for which she received inhaled corticosteroids and statin therapy. She attended routine interval skin checks during an 8year period, when a surplus of 15 total basal cell carcinomas and squamous cell carcinomas were excised and confirmed with subsequent histopathological diagnosis. Both acitretin and nicotinamide were unsuccessfully trialled, alongside extensive photoprotection measures.