Keratoacanthoma Treatment & Management

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

Medical Care

Treatment of keratoacanthoma (KA) is primarily surgical. Reserve medical treatment for exceptional cases where surgical intervention is either not feasible or desirable. For example, medical intervention may be appropriate in patients with multiple lesions, in lesions not amenable to surgery because of size or location, and in patients with comorbidities that dissuade surgical procedure.

Systemic retinoids, such as isotretinoin, are a consideration for patients with lesions too numerous for surgical intervention.

Intralesional methotrexate (MTX),[20] 5-fluorouracil, bleomycin, and steroids have been used with success in patients who are either poor surgical candidates or have lesions not amenable to surgery because of size or location.[12, 21] A 2007 review of the use of intralesional injection of MTX on 38 patients, including 18 of the researchers' patients, showed a 92% clinical "resolution" rate; however, patients needed an average of 2.1 injections to achieve it. Only 13% (5 patients) obtained histological confirmation.[22] Both topical imiquimod and 5-fluorouracil have been used with anecdotal success.[23]

Note much of the literature concerning medical intervention for keratoacanthoma is limited to case reports and of unproved efficacy. Be cautious when making the decision to pursue medical in lieu of surgical intervention and perform appropriate follow-up.

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Surgical Care

The primary therapy for keratoacanthoma is surgical excision of the tumor.

  • Excise tumors with adequate margins (3-5 mm) and histopathologic evaluation to exclude invasive SCC.
  • Partial shave biopsy usually inadequately distinguishes between keratoacanthoma and invasive SCC.
  • In some patients, smaller lesions may be treated with deep excisional shave and curettage or other destructive techniques.
  • Because the biological behavior of an individual keratoacanthoma cannot be predicted, many consider surgical treatment of keratoacanthoma to be equivalent to treatment for SCC.
  • Mohs micrographic surgery may be indicated for large or recurrent keratoacanthomas or keratoacanthomas located in anatomic areas with cosmetic or functional considerations.

Keratoacanthomas are radiosensitive and respond well to low doses of radiation (< 10 Gy). Radiation therapy may be useful in selected patients with large tumors in whom resection will result in cosmetic deformity or for tumors that have recurred following attempted excisional surgery. Radiation therapy is less appealing in younger patients in whom radiation damage worsens with time. Radiation therapy is an important alternative treatment for selected patients who understand the risks and benefits, who are not good surgical candidates, or who lack access to Mohs surgery.

Both laser therapy and cryotherapy have been used successfully in small keratoacanthomas, in keratoacanthomas found in difficult to treat locations, and as an adjunct to surgical removal.

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Consultations

Consult a dermatologist to exclude invasive squamous cell carcinoma (SCC).

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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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