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An 81-year-old Japanese male was referred to our clinic in 1991 with multiple Bowen's disease. The associated hyperpigmentation of the trunk and extremities and palmoplantar keratotic nodules indicated that he had suffered from chronic arsenic poisoning. Interestingly, he was a native of Namikata in Ehime, Japan, where many residents have suffered from multiple Bowen's disease with internal malignancy. Arsenic exposure was strongly suspected. Two years later, Merkel cell carcinoma developed on the dorsum of his right hand, where Bowen's disease lesions were absent. Metastasis of this Merkel cell carcinoma led to his eventual death one year later. To our knowledge, this is the first report of Merkel cell carcinoma associated with multiple Bowen's disease. Chronic arsenic poisoning may be responsible for the association of these two rare skin neoplasms.

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An 89-year-old woman presented a rapidly growing red nodule of 5 years' duration on her left eyelid. Histologically, the entire dermis was occupied by multiple lobules of atypical tumor cell nests surrounded by inflammatory cells and fibrous stroma. The tumor cell nests were connected with the overlying epidermis and extended into the subcutaneous fat and muscles. There were no tendencies towards squamous or glandular differentiation of the tumor cells. Immunohistochemistry showed the tumor cells to be positive for keratin/cytokeratin and epithelial membrane antigen, but negative for neuron specific enolase and vasoactive intestinal polypeptide. S-100 protein-positive Langerhans cells were also found within the tumor nests. There was no apparent evidence of a primary lesion elsewhere.