Keratoacanthoma with perineural invasion: An indicator for aggressive behavior?

Abstract

Neurotropic invasion of keratoacanthoma (KA) is rare and can easily be missed histologically. A 36-year-old woman developed a KA on the upper lip four weeks after CO(2) laser skin resurfacing; it showed microscopic evidence of perineural invasion. Despite repeated treatment with intralesional methotrexate, the KA recurred after 6 months. She was then treated with ionizing radiation (56 Gy) and has been tumor-free for more than 3 years. Immunohistochemistry showed decreased expression of desmoglein 1 as it is seen in squamous cell carcinomas. In most cases not much importance is attached to perineural invasion which is frequently seen in KA because of the high rate of spontaneous regression. Our case suggests that perineural invasion may be an indicator for aggressive growth of head-and-neck KAs so that histologically-controlled excision is recommended.

Keratoacanthoma of the Head and Neck with Perineural Invasion: Incidental Finding or Cause for Concern?

“…Four of the articles are case series that represent a total of 102 patients, 2,3,4,9 and three articles are single-patient case reports. [10][11][12] Godbolt and colleagues histologically identified 40 cases of KA with PNI with the following distribution: head and neck (27), extremities (8), trunk (4), and unknown (1). 2 All cases were treated initially with wide local excision.…”

“…Basoglu and colleagues report a 36-year-old woman who developed a perioral KA with PNI that recurred despite treatment with intralesional methotrexate. 10 Wagner reports a single patient with the syndrome of sporadic multiple self-healing SCCs. 12 Of this patient's numerous KAs, three neoplasms demonstrated PNI.…”

Don‘t miss the base – keratoacanthoma‐type squamous cell carcinoma with perineural invasion during BRAF inhibitor therapy for melanoma

“…According to the literature, it occurs in up to 4% of cases, particularly often in head and neck tumors [11]. Although larger case series have not shown any effect on clinical outcome, reports of aggressive and malignant disease courses with involvement of facial muscles and nerves as well as local recurrence and metastasis have been published [12,13]. Apart from the size of the affected nerve, loss of adhesion molecules such as desmoglein 1 has been suggested as a histological predictor of clinically aggressive behavior [12,13].…”

“…Although larger case series have not shown any effect on clinical outcome, reports of aggressive and malignant disease courses with involvement of facial muscles and nerves as well as local recurrence and metastasis have been published [12,13]. Apart from the size of the affected nerve, loss of adhesion molecules such as desmoglein 1 has been suggested as a histological predictor of clinically aggressive behavior [12,13]. In case of extensive perineural invasion, the prognosis might possibly correspond to that of squamous cell carcinoma with perineural infiltration [13].…”

Well‐differentiated squamous cell carcinoma as a complication of the 1927‐nm thulium nonablative fractional laser

“…While lasers are frequently used to safely improve dermal and epidermal imperfections, these treatments may also have unexpected adverse effects. For instance, there are rare reports of nonmelanoma skin cancer occurrence following ablative and fractional laser resurfacing 1‐6 . It is crucial that dermatologists have a comprehensive understanding of the side effect profiles of the lasers we utilize to best inform patients about procedural risks, and to anticipate and manage complications when they occur.…”