Keratoacanthoma Clinical Presentation
- Author: Tsu-Yi Chuang, MD, MPH, FAAD; Chief Editor: William D James, MD more...
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.
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.
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 ultraviolet light 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. Additionally, a 2006 study suggested a strong association between cigarette smoking and the development of keratoacanthoma.
Trauma (iatrogenic or noniatrogenic), human papillomavirus (specifically types 9, 11, 13, 16, 18, 24, 25, 33, 37, and 57),[17, 18] genetic factors, and immunocompromised status also have been implicated as etiologic factors.
Merkel cell polyomavirus does not play a pathogenic role in keratoacanthoma.
Twenty percent of patients who had metastatic melanoma and were treated with vemurafenib, a novel BRAF V600E inhibitor, may develop eruptive keratoacanthoma or squamous cell carcinoma.
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.[21, 22, 23, 24]
Manstein CH, Frauenhoffer CJ, Besden JE. Keratoacanthoma: is it a real entity?. Ann Plast Surg. 1998 May. 40(5):469-72. [Medline].
Gleich T, Chiticariu E, Huber M, Hohl D. Keratoacanthoma: A distinct entity?. Exp Dermatol. 2015 Oct 17. [Medline].
Ra SH, Su A, Li X, Zhou J, Cochran AJ, Kulkarni RP, et al. Keratoacanthoma and squamous cell carcinoma are distinct from a molecular perspective. Mod Pathol. 2015 Jun. 28(6):799-806. [Medline].
Kanzaki A, Kudo M, Ansai S, Peng WX, Ishino K, Yamamoto T, et al. Insulin-like growth factor 2 mRNA-binding protein-3 as a marker for distinguishing between cutaneous squamous cell carcinoma and keratoacanthoma. International journal of oncology. 2016 Mar. 48(3):1007-15. [Medline].
Schwartz RA. Keratoacanthoma. J Am Acad Dermatol. 1994 Jan. 30(1):1-19; quiz 20-2. [Medline].
Magalhaes 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. 2008 Jul-Aug. 12(4):163-73. [Medline].
Kossard S, Tan KB, Choy C. Keratoacanthoma and infundibulocystic squamous cell carcinoma. Am J Dermatopathol. 2008 Apr. 30(2):127-34. [Medline].
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].
Macdonald JB, Macdonald B, Golitz LE, LoRusso P, Sekulic A. Cutaneous adverse effects of targeted therapies: Part II: Inhibitors of intracellular molecular signaling pathways. J Am Acad Dermatol. 2015 Feb. 72 (2):221-36; quiz 237-8. [Medline].
Chuang TY, Reizner GT, Elpern DJ, Stone JL, Farmer ER. Keratoacanthoma in Kauai, Hawaii. The first documented incidence in a defined population. Arch Dermatol. 1993 Mar. 129(3):317-9. [Medline].
Chuang TY, Reizner GT, Elpern DJ, Stone JL, Farmer ER. Squamous cell carcinoma in Kauai, Hawaii. Int J Dermatol. 1995 Jun. 34(6):393-7. [Medline].
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. 1993 Oct. 32(10):717-8. [Medline].
Reizner GT, Chuang TY, Elpern DJ, Stone JL, Farmer ER. Keratoacanthoma in Japanese Hawaiians in Kauai, Hawaii. Int J Dermatol. 1995 Dec. 34(12):851-3. [Medline].
Reizner GT, Chuang TY, Elpern DJ, Stone JL, Farmer ER. Basal cell carcinoma and keratoacanthoma in Hawaiians: an incidence report. J Am Acad Dermatol. 1993 Nov. 29(5 Pt 1):780-2. [Medline].
Letzel S, Drexler H. Occupationally related tumors in tar refinery workers. J Am Acad Dermatol. 1998 Nov. 39(5 Pt 1):712-20. [Medline].
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. 2006 Feb 28. 12(2):2. [Medline].
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. 1997 Feb. 19(1):10-5. [Medline].
Lu S, Syrjanen SL, Havu VK, Syrjanen S. Known HPV types have no association with keratoacanthomas. Arch Dermatol Res. 1996 Mar. 288(3):129-32. [Medline].
Wieland U, Scola N, Stolte B, Stucker M, Silling S, Kreuter A. No evidence for a causal role of Merkel cell polyomavirus in keratoacanthoma. J Am Acad Dermatol. 2012 Jul. 67(1):41-6. [Medline].
Alloo A, Garibyan L, LeBoeuf N, et al. Photodynamic therapy for multiple eruptive keratoacanthomas associated with vemurafenib treatment for metastatic melanoma. Arch Dermatol. 2012 Mar. 148(3):363-6. [Medline].
Clausen OP, Beigi M, Bolund L, et al. Keratoacanthomas frequently show chromosomal aberrations as assessed by comparative genomic hybridization. J Invest Dermatol. 2002 Dec. 119(6):1367-72. [Medline].
Kim DK, Kim JY, Kim HT, Han KH, Shon DG. A specific chromosome aberration in a keratoacanthoma. Cancer Genet Cytogenet. 2003 Apr 1. 142(1):70-2. [Medline].
Cabibi D, Conway de Macario E, Ingrao S, Porcasi R, Zucco F, Macario AJ, et al. CD1A-positive cells and HSP60 (HSPD1) levels in keratoacanthoma and squamous cell carcinoma. Cell Stress Chaperones. 2015 Oct 6. [Medline].
Hatta N, Takata A, Ishizawa S, Niida Y. Family with MSH2 mutation presenting with keratoacanthoma and precancerous skin lesions. J Dermatol. 2015 Nov. 42 (11):1087-90. [Medline].
Meffert JJ. Cutaneous sporotrichosis presenting as a keratoacanthoma. Cutis. 1998 Jul. 62(1):37-9. [Medline].
Patel NP, Cervino AL. Treatment of keratoacanthoma: Is intralesional methotrexate an option?. Can J Plastic Surg. Summer 2011. (19)2:e15-8.
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. 2002 Oct. 28(10):954-8. [Medline].
Sayama S, Tagami H. Treatment of keratoacanthoma with intralesional bleomycin. Br J Dermatol. 1983 Oct. 109(4):449-52. [Medline].
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. 2007 Jun. 56(6):989-93. [Medline].
Dendorfer M, Oppel T, Wollenberg A, Prinz JC. Topical treatment with imiquimod may induce regression of facial keratoacanthoma. Eur J Dermatol. 2003 Jan-Feb. 13(1):80-2. [Medline].
Grob JJ, Suzini F, Richard MA, et al. Large keratoacanthomas treated with intralesional interferon alfa-2a. J Am Acad Dermatol. 1993 Aug. 29(2 Pt 1):237-41. [Medline].
Canas GC, Robson KJ, Arpey CJ. Persistent keratoacanthoma: challenges in management. Dermatol Surg. 1998 Dec. 24(12):1364-9. [Medline].
Frank TL, Maguire HC Jr, Greenbaum SS. Multiple painful keratoacanthomas. Int J Dermatol. 1996 Sep. 35(9):648-50. [Medline].