Aggressive Keratoacanthoma of the Eyelid: “Malignant” Keratoacanthoma or Squamous Cell Carcinoma?

Abstract

We report an aggressive keratoacanthoma of the upper eyelid that recurred at the site of a previously excised keratoacanthoma. The diagnosis was confirmed by biopsy. Because the surgery required would be extensive, medical therapy was tried first. The tumor was treated with intralesional injections of 5-fluorouracil and radiotherapy. Despite this therapy, the orbital computed tomogram showed tumor extension into the orbit, and an orbital exenteration was performed. Histopathology of the excised tumor was consistent with squamous cell carcinoma. We discuss the topic of malignant transformation of the keratoacanthoma.

Keratoacanthoma: A Clinico-Pathologic Enigma

“…KA progressing to SCC with metastatic spread is rare; however, KA-like SCCs are not uncommon. 1,42,44,50,[66][67][68][69] In addition, KA may have increased aggressive potential in immunosuppressed patients. The progression of a KA into SCC in a patient with Hodgkin's disease receiving polychemotherapy has been observed; this raises the question of whether the transformation into SCC may have resulted from a mutagenic effect of the chemotherapy.…”

Intralesional agents in the management of cutaneous malignancy: A review

“…Furthermore, as there have been rare reports of metastasis with KAs, many dermatologists now simply manage them as any other nonmelanoma skin cancer. 29,30 As the details of this controversy exceed this review, in this section, the management of KA will be discussed alongside invasive SCC.…”

Trisomy 7 in keratoacanthoma and squamous cell carcinoma detected by fluorescence in‐situ hybridization

“…In its otiginal description, KA was considered a clinically and histologiciilly distinct lesion (1). However, as data has accumulated, incltiding the findings of aggressive ancl metastatic KAs, many investigators have concluded that KA is a type of squamous cell carcinoma with potential for involution as well as aggressive behavior and metastasis (2)(3)(4)(5)(6)(7)(8). Studies regarding oncogenesis have demonstrated similar mutant p53 protein expression in KAs and WD-SCCs, supporting the concept that KA is a type of WDSCC (9).…”