Keratoacanthoma Clinical Presentation

  • Author: Tsu-Yi Chuang, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 18, 2011
 

History

Keratoacanthoma (KA) typically grows rapidly, attaining 1-2 cm within weeks, followed by a slow involution period lasting up to 1 year and leaving a residual scar if not excised preemptively. Since expedient therapy almost always is instituted, the true natural course of the tumor cannot be confirmed with certainty.

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Physical

Pertinent physical findings in keratoacanthoma (KA) are limited to the skin. Lesions typically are solitary and begin as firm, roundish, skin-colored or reddish papules that rapidly progress to dome-shaped nodules with a smooth shiny surface and a central crateriform ulceration or keratin plug that may project like a horn. Most keratoacanthomas occur on sun-exposed areas. The face, neck, and dorsum of the upper extremities are common sites. Truncal lesions are rare. Lesions usually are skin-colored to pinkish-red. Unaffected skin retains its normal appearance. Note the images below.

Keratoacanthoma (squamous cell carcinoma-keratoacaKeratoacanthoma (squamous cell carcinoma-keratoacanthoma or SCC-KA type) on inner canthus. Keratoacanthoma of the left forehead. Keratoacanthoma of the left forehead. Close-up view of the keratoacanthoma. Close-up view of the keratoacanthoma. Keratoacanthoma lesion (squamous cell carcinoma-keKeratoacanthoma lesion (squamous cell carcinoma-keratoacanthoma or SCC-KA type).
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Causes

The definitive cause of keratoacanthoma (KA) remains unclear; however, several potentiating factors should be considered. Epidemiologic data of keratoacanthoma is notably similar to SCC and Bowen disease (SCC in situ) concerning age, sex, and the anatomic site of lesions. These data strongly support a common etiology among keratoacanthoma, SCC, and Bowen disease. Epidemiologic data support sunlight as an important etiologic factor.

Industrial workers exposed to pitch and tar have been well established as having a higher incidence of keratoacanthoma, as well as SCC.[13] Additionally, a 2006 study suggested a strong association between cigarette smoking and the development of keratoacanthoma.[14]

Trauma, human papillomavirus (specifically types 9, 11, 13, 16, 18, 24, 25, 33, 37, and 57),[15, 16] genetic factors, and immunocompromised status also have been implicated as etiologic factors.

Finally, research has identified that up to one third of keratoacanthomas harbor chromosomal aberrations. Recurrent aberrations include gains on 8q, 1p, and 9q with deletions on 3p, 9p, 19p, and 19q. One other report identified a 46,XY,t(2;8)(p13;p23) chromosomal aberration.[17, 18]

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Contributor Information and Disclosures
Author

Tsu-Yi Chuang, MD, MPH  Clinical Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Staff Dermatologist, Desert Oasis Healthcare

Tsu-Yi Chuang, MD, MPH is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and International Society of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Ryan Brashear, MD  Staff Physician, Department of Dermatology, Indiana University School of Medicine

Ryan Brashear, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Susan M Swetter, MD  Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, Pacific Dermatologic Association, Society for Investigative Dermatology, Society for Melanoma Research, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

John G Albertini, MD  Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME Accredited Fellowship in Procedural Dermatology

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Manstein CH, Frauenhoffer CJ, Besden JE. Keratoacanthoma: is it a real entity?. Ann Plast Surg. May 1998;40(5):469-72. [Medline].

  2. Schwartz RA. Keratoacanthoma. J Am Acad Dermatol. Jan 1994;30(1):1-19; quiz 20-2. [Medline].

  3. Magalhães RF, Cruvinel GT, Cintra GF, Cintra ML, Ismael AP, de Moraes AM. Diagnosis and follow-up of keratoacanthoma-like lesions: clinical-histologic study of 43 cases. J Cutan Med Surg. Jul-Aug 2008;12(4):163-73. [Medline].

  4. Kossard S, Tan KB, Choy C. Keratoacanthoma and infundibulocystic squamous cell carcinoma. Am J Dermatopathol. Apr 2008;30(2):127-34. [Medline].

  5. Cribier B, Asch P, Grosshans E. Differentiating squamous cell carcinoma from keratoacanthoma using histopathological criteria. Is it possible? A study of 296 cases. Dermatology. 1999;199(3):208-12. [Medline].

  6. [Best Evidence] Chuang TY, Reizner GT, Elpern DJ, Stone JL, Farmer ER. Keratoacanthoma in Kauai, Hawaii. The first documented incidence in a defined population. Arch Dermatol. Mar 1993;129(3):317-9. [Medline].

  7. [Best Evidence] Chuang TY, Reizner GT, Elpern DJ, Stone JL, Farmer ER. Squamous cell carcinoma in Kauai, Hawaii. Int J Dermatol. Jun 1995;34(6):393-7. [Medline].

  8. [Best Evidence] Chuang TY, Reizner GT, Elpern DJ, Stone JL, Farmer ER. Non-melanoma skin cancer and keratoacanthoma in Filipinos: an incidence report from Kauai, Hawaii. Int J Dermatol. Oct 1993;32(10):717-8. [Medline].

  9. [Best Evidence] Reizner GT, Chuang TY, Elpern DJ, Stone JL, Farmer ER. Keratoacanthoma in Japanese Hawaiians in Kauai, Hawaii. Int J Dermatol. Dec 1995;34(12):851-3. [Medline].

  10. [Best Evidence] Reizner GT, Chuang TY, Elpern DJ, Stone JL, Farmer ER. Basal cell carcinoma and keratoacanthoma in Hawaiians: an incidence report. J Am Acad Dermatol. Nov 1993;29(5 Pt 1):780-2. [Medline].

  11. Frank TL, Maguire HC Jr, Greenbaum SS. Multiple painful keratoacanthomas. Int J Dermatol. Sep 1996;35(9):648-50. [Medline].

  12. Sanders S, Busam KJ, Halpern AC, Nehal KS. Intralesional corticosteroid treatment of multiple eruptive keratoacanthomas: case report and review of a controversial therapy. Dermatol Surg. Oct 2002;28(10):954-8. [Medline].

  13. Letzel S, Drexler H. Occupationally related tumors in tar refinery workers. J Am Acad Dermatol. Nov 1998;39(5 Pt 1):712-20. [Medline].

  14. Miot HA, Miot LD, da Costa AL, Matsuo CY, Stolf HO, Marques ME. Association between solitary keratoacanthoma and cigarette smoking: a case-control study. Dermatol Online J. Feb 28 2006;12(2):2. [Medline].

  15. Hsi ED, Svoboda-Newman SM, Stern RA, Nickoloff BJ, Frank TS. Detection of human papillomavirus DNA in keratoacanthomas by polymerase chain reaction. Am J Dermatopathol. Feb 1997;19(1):10-5. [Medline].

  16. Lu S, Syrjänen SL, Havu VK, Syrjänen S. Known HPV types have no association with keratoacanthomas. Arch Dermatol Res. Mar 1996;288(3):129-32. [Medline].

  17. Clausen OP, Beigi M, Bolund L, et al. Keratoacanthomas frequently show chromosomal aberrations as assessed by comparative genomic hybridization. J Invest Dermatol. Dec 2002;119(6):1367-72. [Medline].

  18. Kim DK, Kim JY, Kim HT, Han KH, Shon DG. A specific chromosome aberration in a keratoacanthoma. Cancer Genet Cytogenet. Apr 1 2003;142(1):70-2. [Medline].

  19. Meffert JJ. Cutaneous sporotrichosis presenting as a keratoacanthoma. Cutis. Jul 1998;62(1):37-9. [Medline].

  20. Patel NP, Cervino AL. Treatment of keratoacanthoma: Is intralesional methotrexate an option?. Can J Plastic Surg. Summer 2011;(19)2:e15-8.

  21. Sayama S, Tagami H. Treatment of keratoacanthoma with intralesional bleomycin. Br J Dermatol. Oct 1983;109(4):449-52. [Medline].

  22. Annest NM, VanBeek MJ, Arpey CJ, Whitaker DC. Intralesional methotrexate treatment for keratoacanthoma tumors: a retrospective study and review of the literature. J Am Acad Dermatol. Jun 2007;56(6):989-93. [Medline].

  23. Dendorfer M, Oppel T, Wollenberg A, Prinz JC. Topical treatment with imiquimod may induce regression of facial keratoacanthoma. Eur J Dermatol. Jan-Feb 2003;13(1):80-2. [Medline].

  24. Grob JJ, Suzini F, Richard MA, et al. Large keratoacanthomas treated with intralesional interferon alfa-2a. J Am Acad Dermatol. Aug 1993;29(2 Pt 1):237-41. [Medline].

  25. Canas GC, Robson KJ, Arpey CJ. Persistent keratoacanthoma: challenges in management. Dermatol Surg. Dec 1998;24(12):1364-9. [Medline].

 
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Keratoacanthoma (squamous cell carcinoma-keratoacanthoma or SCC-KA type) on inner canthus.
Keratoacanthoma of the left forehead.
Close-up view of the keratoacanthoma.
Keratoacanthoma lesion (squamous cell carcinoma-keratoacanthoma or SCC-KA type).
 
 
 
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