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Three families are described. A number of the members of these families showed nummular keratoses on the plantar pressure points. The lesions usually appeared when the children began to walk. They progressed slowly and were often accompanied by pain. The hands showed only minor lesions, which frequently followed manual labor. Extrapalmoplantar lesions were rare. The histopathologic findings in our patients were those of focal epiderrnolytic hyperkeratosis. The classification of this type of dominant hereditary focal palmoplantar keratosis, for which the name keratosis palmoplantaris nummularis is suggested, is discussed.

Thirty-one patients with Bowen's disease were studied in a restricted district of Namikata and its neighborhood of Ehime, Japan. Nineteen were alive and 12 were dead; the youngest living patient was 52 years of age. Invasive skin cancers were found in 10 patients and internal malignancies in 10, including 7 patients with pulmonary cancers. Palmoplantar keratosis was present in 25 patients and raindrop-type pigment anomalies in 15. Neutron activation analysis of hair showed only slightly higher arsenic values in patients with Bowen's disease than those in normal controls, though the differences were statistically significant at p less than 0.05. A possible arsenic exposure 43 years previously was considered responsible for the occurrence of neoplasms, though the arsenic route and amount were not determined. Bowen's disease started within 10 years, invasive skin cancers after 20 years, and pulmonary cancers after 30 years following the suspected arsenic exposure.