Tumor with central crusting
In just 6 weeks, a small, hard papule on the left cheek had become a prominent 2.1×1.8 cm well-circumscribed tumor.
When in doubt, cut it out
Although the natural course of a keratoacanthoma is spontaneous regression, the lack of reliable criteria to differentiate it from an SCC with confidence renders therapeutic intervention the safest approach. Solitary keratoacanthomas respond well to surgical excision and may require aggressive procedures if they become too large or invade other structures. Since Mohs’ micrographic surgery is tissue sparing, consider it the treatment of choice if the keratoacanthoma is located in a sensitive area, such as the face.
Cryotherapy with liquid nitrogen, electrodessication and curettage, radiation therapy, and CO2 laser surgery have all been used in small solitary keratoacanthomas with good success.9,10 Other treatment options include intralesional and/or topical treatment using several compounds, such as 5-fluorouracil, corticosteroids, bleomycin, imiquimod, interferon alpha 2b, and methotrexate.7,9-13
Keratoacanthoma patients are often UV light sensitive, so they must avoid excessive sun exposure and use sunscreen with high SPF at all times to prevent recurrence and minimize scarring.
We opted for Mohs’ surgery for our patient
Given the cosmetically sensitive location of our patient’s keratoacanthoma, the size of it, and the patient’s history of skin cancers, we decided to use Mohs’ micrographic surgery for the management of this tumor, with good clinical outcome. There were no new lesions or recurrence on follow-up visit 6 months later.
Correspondence
Amor Khachemoune, MD, CWS, Assistant Professor, Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 530 First Avenue, Suite 7R, New York, NY 10016; amorkh@pol.net.
