eMedicine Specialties > Dermatology > Malignant Neoplasms

Keratoacanthoma: Follow-up

Author: Tsu-Yi Chuang, MD, MPH, Clinical Professor, Department of Dermatology, University of Southern California; Staff Dermatologist, Desert Specialty Group, Inc
Coauthor(s): Ryan Brashear, MD, Staff Physician, Department of Dermatology, Indiana University School of Medicine
Contributor Information and Disclosures

Updated: Mar 11, 2009

Follow-up

Further Outpatient Care

  • Patients who develop nonmelanoma skin cancer, such as keratoacanthoma, SCC, Bowen disease, or basal cell carcinoma, are at high risk for developing subsequent nonmelanoma skin cancer. Education, periodic follow-up examinations, and early detection and treatment of actinic keratosis and skin cancer are important in these patients.

Prognosis

  • Prognosis is excellent following excisional surgery.
  • Recurrent tumors may require more aggressive therapy.
  • Follow patients with a history of keratoacanthoma for development of new primary skin cancers (SCC in particular).

Patient Education

  • Educate patients about prevention (including sunscreen), sun-protection techniques, and skin self-examination.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose keratoacanthoma can result in substantial morbidity and, occasionally, mortality. Since both metastatic disease and local destruction have been reported with keratoacanthoma, accurate diagnosis is critical. Physicians diagnosing and/or treating keratoacanthoma are held legally responsible for actions (or actions not taken) that fall outside of the standard of care.
  • Failure to treat keratoacanthoma appropriately may result in unacceptably high levels of recurrence and metastasis, or in other cases, may result in an unfavorable risk-to-benefit ratio. Since over or under treating keratoacanthoma can have untoward effects, physicians treating keratoacanthoma bear the liability for selecting and performing the appropriate level of treatment.
  • Failure to educate patients about prevention, self-examination, and the nature of the tumor may result ultimately in an unacceptable level of morbidity and mortality. Since keratoacanthoma is a strong risk factor for future occurrences of nonmelanoma skin cancer and may be a marker for internal malignancy in the context of some syndromes, appropriate education and follow-up must be performed.

Special Concerns

  • Be sure to rule out SCC.
 


More on Keratoacanthoma

Overview: Keratoacanthoma
Differential Diagnoses & Workup: Keratoacanthoma
Treatment & Medication: Keratoacanthoma
Follow-up: Keratoacanthoma
Multimedia: Keratoacanthoma
References
[ CLOSE WINDOW ]

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. 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].

  4. 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].

  5. 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].

  6. 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].

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

  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. Oct 2002;28(10):954-8. [Medline].

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

  10. 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].

  11. 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].

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

  13. 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].

  14. 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].

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

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

  17. 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].

  18. 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].

  19. 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].

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

  21. Fitzpatrick T, Eisen A, Wolff K, et al, eds. Keratoacanthoma. In: Dermatology in General Medicine. 1993. 4th ed. New York, NY: McGraw-Hill; 848-855.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

keratoacanthoma, KA, squamous cell carcinoma, SCC, invasive SCC, invasive squamous cell carcinoma, squamous cell cancer, skin cancer, skin malignancy, pilosebaceous gland cancer, pilosebaceous glands

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Tsu-Yi Chuang, MD, MPH, Clinical Professor, Department of Dermatology, University of Southern California; Staff Dermatologist, Desert Specialty Group, Inc
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.

Medical Editor

Susan M Swetter, MD, Director, Pigmented Lesion and Cutaneous Melanoma Clinic, Associate 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.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
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.

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center
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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.