- Email: [email protected]
Multiple keratoses and squamous cell carcinoma from cutting oil
Volume 27 Number 5, Part 1 November 1992
3. MacKenna RW, ed. Diseases of the skin. 4th ed. London: Bailliere Tindall & Cox, 1937:467. 4. Bertolin AP, Freedberg IM. Disorders of epiderrnalappendages and related disorders. In: Fitzpatrick TB, Eisen AZ, Wolff K, eds. Dermatology in general medicine. New York: McGraw-Hill, 1987:627-51. 5. Ebling FJG, Dawber R, Rook A. The hair. In: Rook A, Wilkinson DS, Ebling FJG, et al, eds. Textbook of dermatology. Oxford: Blackwell Scientific, 1986:1990.
Brief communications
767
6. Rook A, Dawber R, eds. Diseases of the hair and scalp. Oxford: Blackwell Scientific, 1982. 7. Sauder DN. Alopeeia areata: an inherited autoimrnune disease. In: Brown AC, Crounse RG, eds. Hair, tract elements and human illness. New York: Praeger, 1980: 343-8.
Multiple keratoses and squamous cell carcinoma from cutting oil Takuo Tsuji, MD, Naoki Otake, MD, Taisuke Kobayashi, MD, and N o r i m a s a Miwa, M D
Nagoya, Japan Workers exposed to tar, pitch, creosote, anthracene, shale oil, arsenic, or mineral oil have keratoses and even skin cancers. 1 In workers in the machine tool, screwcutting and grooving industries, 2 the probable cause is cutting oil. 3 Recent experimental studies with cutting oil in animal skin prove both used and unused oil can act as potent tumor initiators. 4 W e report a case of multiple keratoses and squamous cell carcinoma that occurred in skin exposed to cutting oil. As far as we know there has been no report of this for at least 10 years. CASE REPORT
A 58-year-old Japanese man reported multiple keratotic lesions on his forearms and the backs of his hands. He had used cutting oil (neat oil, mineral oil base) for metal-cutting machines 9 hours daily except Sundays and holidays for about 15 years. The patient had first noticed the skin lesions about 5 years earlier. One on the right forearm had grown to a large nodule in about 1 year. These lesions corresponded to the areas exposed to the cutting oil. There was no history of exposure to arsenic. Physical examination revealed many scaly or keratotic plaques, papules, and nodules with or without pigmentation, varying in size (2 to 20 mm in diameter) and shape, on the extensor and flexor aspects of his forearms and backs of his hands (Fig. 1). On the flexor surface of the From the Departmentof Dermatology,NagoyaCityUniversityMedical School. Reprint requests: Takuo Tsuji, MD, Department of Dermatology, Nagoya City UniversityMedicalSchool,Mizuho-cho,Mizuho-ku, Nagoya 467, Japan. 16/54/38465
Fig. 1. Numerous keratotic skin lesions including a large nodule on extensor aspects of both forearms.
right forearm there was a 3 cm crateriform nodule. The nodule was excised, and the other lesions were treated with cryosurgery. Histologic examination of the keratotic plaques and papules showed marked hyperkeratosis and acanthosis. Some papules showed considerable cellular activity in the malpighian layer and atypical cells and proliferation of some epithelial strands into the dermis (Fig. 2, A). The large nodule revealed an invading tumor consisting of irregular ma~es of epidermal cells that invaded the dermis. The tumor masses showed atypical squamous cell hyper-
768
Journal of the American Academy of Dermatology
BrieJ'communications
; "
~
~,~'-~.i~~.~,,'.~':.'...
.
.
.
Fig. 2. A, Keratotic plaque shows marked hyperkeratosis and atrophy of epidermis. B, Large nodule shows proliferation of atypical squamous cells and abnormal keratinization forming horn pearls. (A and B, Hematoxylin-eosin stain; A, • B, X 180.)
plasia including individual cell keratinization, atypical mitosis, and horn pearls (Fig. 2, B). Patch and photopatch tests with the cutting oil were negative. Analysis of the unused cutting oil showed that it contained 12 parts per billion (ppb) of 3,4-benzopyrene. DISCUSSION
Machine oils distilled from petroleum contain polycyclic aromatic hydrocarbons such as benzopyrene, a known carcinogen. 5 Cutting oils have caused squamous cell carcinoma of the skin. 6 The latent period m a y be as long as 20 to 25 years. 7 "Mule spinners' " c a n c e r has continued to decline since 1950. z In addition, no increase in cancer mortality was found in a recent study of 219 grinders working for at least 5 years between 1950 and 1966. 8 This may be due, in part, to safer lubricants, to changes in machinery, and to a reduction in the number of persons employed in this occupation.
REFERENCES
I. Henry SA. Occupational cutaneous cancer attributable to certain chemicals in industry. Br Meal Bull 1947;4:389-401. 2. Catchpole WM, MacMillan E, Powel H. Specification for cutting oils with special reference to carcinogenicity. Ann Occup Hyg 1971;14:171-9. 3. Cruickshank CND, Squires JR. Skin cancer in engineering industry from the use of mineral oils. Br J Indust Med 1950;7:1-11. 4. Gupta KP, Mehrotra NK. Tumor initiation in mouse skin by cutting oils. Environ Res 1989;49:225-32. 5. Fulk HL, Hotin P, Mehler A. Polycyc|ic hydrocarbons as carcinogens for man. Arch Environ Health 1964;8:721-30. 6. Waldron HA. A brief history of scrotal cancer. Br J Indust Meal 1983;40:390-401. 7. Emrnett EA. Occupational skin cancer: a review. J Occup Meal 1975;17:44-9. 8. Jarholm B, Lavenivis B, Sallsten G. Cancer mortality in workers exposed to cutting fluids containing nitrites and amines. Br J Indust Med 1986;43:563-5.
3. MacKenna RW, ed. Diseases of the skin. 4th ed. London: Bailliere Tindall & Cox, 1937:467. 4. Bertolin AP, Freedberg IM. Disorders of epiderrnalappendages and related disorders. In: Fitzpatrick TB, Eisen AZ, Wolff K, eds. Dermatology in general medicine. New York: McGraw-Hill, 1987:627-51. 5. Ebling FJG, Dawber R, Rook A. The hair. In: Rook A, Wilkinson DS, Ebling FJG, et al, eds. Textbook of dermatology. Oxford: Blackwell Scientific, 1986:1990.
Brief communications
767
6. Rook A, Dawber R, eds. Diseases of the hair and scalp. Oxford: Blackwell Scientific, 1982. 7. Sauder DN. Alopeeia areata: an inherited autoimrnune disease. In: Brown AC, Crounse RG, eds. Hair, tract elements and human illness. New York: Praeger, 1980: 343-8.
Multiple keratoses and squamous cell carcinoma from cutting oil Takuo Tsuji, MD, Naoki Otake, MD, Taisuke Kobayashi, MD, and N o r i m a s a Miwa, M D
Nagoya, Japan Workers exposed to tar, pitch, creosote, anthracene, shale oil, arsenic, or mineral oil have keratoses and even skin cancers. 1 In workers in the machine tool, screwcutting and grooving industries, 2 the probable cause is cutting oil. 3 Recent experimental studies with cutting oil in animal skin prove both used and unused oil can act as potent tumor initiators. 4 W e report a case of multiple keratoses and squamous cell carcinoma that occurred in skin exposed to cutting oil. As far as we know there has been no report of this for at least 10 years. CASE REPORT
A 58-year-old Japanese man reported multiple keratotic lesions on his forearms and the backs of his hands. He had used cutting oil (neat oil, mineral oil base) for metal-cutting machines 9 hours daily except Sundays and holidays for about 15 years. The patient had first noticed the skin lesions about 5 years earlier. One on the right forearm had grown to a large nodule in about 1 year. These lesions corresponded to the areas exposed to the cutting oil. There was no history of exposure to arsenic. Physical examination revealed many scaly or keratotic plaques, papules, and nodules with or without pigmentation, varying in size (2 to 20 mm in diameter) and shape, on the extensor and flexor aspects of his forearms and backs of his hands (Fig. 1). On the flexor surface of the From the Departmentof Dermatology,NagoyaCityUniversityMedical School. Reprint requests: Takuo Tsuji, MD, Department of Dermatology, Nagoya City UniversityMedicalSchool,Mizuho-cho,Mizuho-ku, Nagoya 467, Japan. 16/54/38465
Fig. 1. Numerous keratotic skin lesions including a large nodule on extensor aspects of both forearms.
right forearm there was a 3 cm crateriform nodule. The nodule was excised, and the other lesions were treated with cryosurgery. Histologic examination of the keratotic plaques and papules showed marked hyperkeratosis and acanthosis. Some papules showed considerable cellular activity in the malpighian layer and atypical cells and proliferation of some epithelial strands into the dermis (Fig. 2, A). The large nodule revealed an invading tumor consisting of irregular ma~es of epidermal cells that invaded the dermis. The tumor masses showed atypical squamous cell hyper-
768
Journal of the American Academy of Dermatology
BrieJ'communications
; "
~
~,~'-~.i~~.~,,'.~':.'...
.
.
.
Fig. 2. A, Keratotic plaque shows marked hyperkeratosis and atrophy of epidermis. B, Large nodule shows proliferation of atypical squamous cells and abnormal keratinization forming horn pearls. (A and B, Hematoxylin-eosin stain; A, • B, X 180.)
plasia including individual cell keratinization, atypical mitosis, and horn pearls (Fig. 2, B). Patch and photopatch tests with the cutting oil were negative. Analysis of the unused cutting oil showed that it contained 12 parts per billion (ppb) of 3,4-benzopyrene. DISCUSSION
Machine oils distilled from petroleum contain polycyclic aromatic hydrocarbons such as benzopyrene, a known carcinogen. 5 Cutting oils have caused squamous cell carcinoma of the skin. 6 The latent period m a y be as long as 20 to 25 years. 7 "Mule spinners' " c a n c e r has continued to decline since 1950. z In addition, no increase in cancer mortality was found in a recent study of 219 grinders working for at least 5 years between 1950 and 1966. 8 This may be due, in part, to safer lubricants, to changes in machinery, and to a reduction in the number of persons employed in this occupation.
REFERENCES
I. Henry SA. Occupational cutaneous cancer attributable to certain chemicals in industry. Br Meal Bull 1947;4:389-401. 2. Catchpole WM, MacMillan E, Powel H. Specification for cutting oils with special reference to carcinogenicity. Ann Occup Hyg 1971;14:171-9. 3. Cruickshank CND, Squires JR. Skin cancer in engineering industry from the use of mineral oils. Br J Indust Med 1950;7:1-11. 4. Gupta KP, Mehrotra NK. Tumor initiation in mouse skin by cutting oils. Environ Res 1989;49:225-32. 5. Fulk HL, Hotin P, Mehler A. Polycyc|ic hydrocarbons as carcinogens for man. Arch Environ Health 1964;8:721-30. 6. Waldron HA. A brief history of scrotal cancer. Br J Indust Meal 1983;40:390-401. 7. Emrnett EA. Occupational skin cancer: a review. J Occup Meal 1975;17:44-9. 8. Jarholm B, Lavenivis B, Sallsten G. Cancer mortality in workers exposed to cutting fluids containing nitrites and amines. Br J Indust Med 1986;43:563-5.