History: Arsenical keratoses occur in individuals who are exposed to or ingest arsenic either through occupational use ,through their drinking water or through medicaments containing arsenic.In years gone by these "tonics"were used to treat psoriasis and asthma.Arsenical keratoses are a marker for individuals highly at risk of developing SCC,Bowen's disease and superficial BCC as well as internal malignancy.They typically occur on the palms of the hand and soles of the feet but can also be seen on the dorsal surfaces.