Eruptive Keratoacanthomas on the Legs After Fractional Photothermolysis: Report of Two Cases

Mamelak, Adam J.; Goldberg, Leonard Harry; Marquez, Denise; Hosler, Gregory A.; Hinckley, Michael; Friedman, Paul M.

doi:10.1111/j.1524-4725.2009.01068.x

Cited by 33 publications

(25 citation statements)

References 27 publications

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“…Virtually every form of skin therapy that causes inflammation directly or indirectly has been reported as responsible for development of KAs. Examples are cryotherapy, imiquimod, ingenol mebutate (unpublished observation), PDT, UVB, laser treatment, cosmetic peel and photothermolysis . Similar reports of SCCs as a response to external trauma, stress or short‐lived inflammatory reactions, etc.…”

Section: Reactive Kasmentioning

confidence: 76%

Squamous cell carcinoma and keratoacanthomas are biologically distinct and can be diagnosed by light microscopy: a review

et al. 2016

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Keratoacanthomas (KAs) are self-limiting squamoproliferative lesions usually seen on sun damaged skin. These tumours are in many ways enigmatic, and the relation between KAs and squamous cell carcinoma is still a contested topic. In this review the biology and histology of KAs will be discussed, and based on morphology, clinical outcome and recent genetic analysis of the tumour types, we conclude that KAs and SCCs are two distinct biological entities which can usually be distinguished by conventional microscopy. The sentinel observation of rapid and frequent appearance of KAs after BRAF treatment of malignant melanoma patients has paved the way for a more general understanding of the pathogenesis leading to the appearance of KAs in patients with inflammation in the skin. In BRAF treated patients, the KAs are a consequence of paradoxical activation of the MAP kinase pathway. Similarly, any external trauma or pharmaceutical interventions resulting in inflammation in the skin will activate the MAP kinase pathway. Such inflammation-mediated MAP kinase activation in the skin will result in the development of KAs through the same pathway as demonstrated for BRAF treated patients. It is characteristic that skin tumours following short acting inflammatory stimulation of severely sun damaged skin develop almost exclusively into KAs, whereas it is exceedingly rare that such inflammatory conditions lead to formation of SCCs. The understanding that inflammatory reactions in sun-damaged skin may activate pathways specifically leading to the formation of KAs may spare the patient the discomfort and disfigurement of needless overtreatment.

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Section: Reactive Kasmentioning

confidence: 76%

Squamous cell carcinoma and keratoacanthomas are biologically distinct and can be diagnosed by light microscopy: a review

et al. 2016

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“…17 The development of eruptive KA in altered skin has been documented many times previously. Surgical trauma, chemical peels, ablative laser, thermal burns, cryotherapy, tattoos, megavoltage radiotherapy, phototherapy, vaccinations, photodynamic therapy (PDT), and now imiquimod, have all being associated with solitary or eruptive KA [3][4][5][6][7][18][19][20][21][22] . Inflammation appears to be the unifying feature, but how this leads to KA formation remains speculative.…”

Section: Discussionmentioning

confidence: 99%

Eruptive keratoacanthoma and squamous cell carcinoma complicating imiquimod therapy: Response to oral acitretin

Foxton

Delaney

2010

Australasian Journal of Dermatology

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An 87-year-old woman with eruptive keratoacanthomas complicating recent imiquimod therapy is presented. Lesions developed both at and distal to the treatment site. She responded well to 8 weeks of oral acitretin with resolution of most lesions and no recurrence at 6 months post treatment. A remaining lesion was excised and found to be a well-differentiated squamous cell carcinoma. Keratoacanthoma and squamous cell carcinoma should be considered in any patient developing rapidly growing keratotic nodules in association with recent imiquimod therapy. The aetiology and treatment of eruptive keratoacanthomas is briefly discussed.

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“…1-4 A similar case was reported in which a 72-yearold woman with a history of SCC developed keratoacanthomas after a body peel. 3 Finally, a case of eruptive keratoacanthomas occurred after cryotherapy on the sun-exposed nose of a tobacco-smoking man. After application of diclofenac sodium 3% gel, her skin was free of lesions at a 6-month follow-up visit.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Here we present a case of eruptive keratoacanthomas after Jessner's and TCA peel for actinic keratoses that resolved spontaneously. In our patient, the appropriate therapy was no treatment.…”

mentioning

confidence: 99%

Eruptive Keratoacanthomas After Jessners and Trichloroacetic Acid Peel for Actinic Keratosis

Mohr

Fernandez

Krejci‐Manwaring

2013

Dermatologic Surgery

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The authors have indicated no significant interest with commercial supporters. K eratoacanthomas, characterized as a subtype of squamous cell carcinoma (SCC) or a separate benign lesion, remain a management quandary in terms of how to treat these lesions. In our patient, the appropriate therapy was no treatment. Jessner's and trichloroacetic acid (TCA) peel is a medium-depth chemical peel used on facial and nonfacial skin for treatment of actinic keratoses, photoaging, pigment dyschromias, and melasma. Side effects or complications of TCA peel include erythema, peeling, hyperpigmentation, herpes simplex virus type 1 reactivation, scarring, and keratoacanthomas. Trauma to the skin caused by chemical peels, thermal burns, fractional photothermolysis, and cryotherapy, have all been reported to cause keratoacanthomas. 1-4 Here we present a case of eruptive keratoacanthomas after Jessner's and TCA peel for actinic keratoses that resolved spontaneously. Case ReportA 62-year-old Caucasian man, who was a previous smoker with a history of SCC of the tongue, had undergone chemotherapy and radiation and been cancer free for longer than 5 years. He was well known to our dermatology service for treatment of cutaneous nonmelanoma skin cancers. He had a strong history of sun exposure but no current immunosuppression. He had undergone multiple treatments with cryotherapy and topical 5-fluorouracil but continued to exhibit extensive actinic damage. Because of the recalcitrant nature of his actinic keratoses, we proceeded with a Jessner's and TCA peel to his dorsal arms and hands. The areas were degreased with acetone using a 4 by 4-in gauze. A thin layer of Jessner's was applied, followed by two layers of TCA 35% so that a level 2 frost was achieved. Cool saline-soaked gauze was applied to the treated areas for comfort, followed by petrolatum ointment.Two weeks after treatment, the patient returned to clinic with areas of erosion and exuberant granulation of the dorsal wrists and erythema in the remaining treatment area. He reported that the healing process was somewhat painful, and he had been applying petrolatum jelly to the entire treated area twice daily, as instructed.Two weeks later, he returned with verrucous nearly confluent plaques and crusted papules on his dorsal arms and hands ( Figure 1A). Three lesions were biopsied and were found to be consistent with *All the authors are affiliated with the Division

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Eruptive Keratoacanthomas on the Legs After Fractional Photothermolysis: Report of Two Cases

Cited by 33 publications

References 27 publications

Squamous cell carcinoma and keratoacanthomas are biologically distinct and can be diagnosed by light microscopy: a review

Squamous cell carcinoma and keratoacanthomas are biologically distinct and can be diagnosed by light microscopy: a review

Eruptive keratoacanthoma and squamous cell carcinoma complicating imiquimod therapy: Response to oral acitretin

Eruptive Keratoacanthomas After Jessners and Trichloroacetic Acid Peel for Actinic Keratosis

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