Keratoacanthoma

Keratoacanthoma is a skin lesion that erupts in sun damaged skin, rather like a little volcano. It grows for a few months, then may shrink and resolve by itself. Keratoacanthoma is considered by many experts to be a variant of squamous cell carcinoma (SCC). As it cannot be clinically reliably distinguished from more serious forms of skin cancer, keratoacanthomas are usually treated surgically.

Keratoacanthoma may start at the site of a minor injury to sun damaged and hair-bearing skin. At first it may appear as a small pimple or boil and may be squeezed but is found to have a solid core filled with keratin (scale). It then grows rapidly and it may be up to 2cm in diameter by the time it is brought to the attention of the doctor.

Keratoacanthoma

©R Suhonen

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What causes keratoacanthoma?

Keratoacanthoma arises from hair follicle skin cells for unknown reasons.

Some keratoacanthomas appear to be related to infection with human papilloma virus (HPV), the cause of warts, but the majority of keratoacanthomas are not found to be due to HPV.

Treatment

Keratoacanthomas should be treated for several reasons.

• To obtain pathology: keratoacanthoma can be difficult to distinguish from invasive squamous cell carcinoma.
• To be rid of an unsightly, tender or worrisome lesion
• To minimise the scar, which can be more unsightly if the lesion resolves on its own.

Treatment requires destruction of the lesion. Options include:

• Cryotherapy
• Curettage and cautery or another form of electrosurgery
• Excision
• Radiotherapy

Follow-up

If keratoacanthoma recurs, it should be treated again.

Patients with keratoacanthomas are at risk of further similar lesions and other skin cancers.

Multiple keratoacanthomas

There are some rare conditions in which multiple keratoacanthomas appear. These are:

• Grzybowski eruptive keratoacanthomas
• Muir Torre syndrome
• Ferguson-Smith familial keratoacanthoma
• Keratoacanthoma centrifugum marginatum

Management requires surgery as well as oral medications such as acitretin, methotrexate or cyclophosphamide.