Recurrent keratoacanthoma with vascular invasion: A diagnostic and management dilemma

Kurien, Anil; Henderson, Christopher; Lee, Simon

doi:10.1111/j.1440-0960.2009.00537.x

Cited by 3 publications

(3 citation statements)

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“…Neural invasion of KA, as well as a few cases of vascular invasion, have been described in a number of papers. [18][19][20][21][22][23] The biological behaviour in all studies and all reported cases have, without exception, been benign, with only few local recurrences treated successfully with operation. This is in contrast to the behaviour of perineural invasion of cutaneous SCCs.…”

Section: Introductionmentioning

confidence: 77%

“…Another strong argument for the benign nature of KAs stems from the clinical fate of patients with KAs demonstrating neural or venous invasion. Neural invasion of KA, as well as a few cases of vascular invasion, have been described in a number of papers . The biological behaviour in all studies and all reported cases have, without exception, been benign, with only few local recurrences treated successfully with operation.…”

Section: Introductionmentioning

confidence: 94%

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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: Introductionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 94%

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

et al. 2016

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“…In addition to the recurrence of KA after surgical resection, the trauma of the operation itself is also the cause of KA[ 21 ]. For recurrent KA, combined treatment measures are thus necessary, including surgical resection combined with radiotherapy and injection of triamcinolone acetonide, YAG laser combined with local injection of 5-fluorouracil, and local application of imiquimod after surgical treatment, which can achieve good results[ 18 , 22 , 23 ]. In this case, surgical resection and topical application of tretinoin cream were used for recurrent KA, which effectively prevented disease recurrence.…”

Section: Discussionmentioning

confidence: 99%

Lower lip recurrent keratoacanthoma: A case report

Liu¹,

Liu²,

Wang³

et al. 2022

WJCC

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BACKGROUND This paper introduces a case of recurrent keratoacanthoma (KA). KA is a self-healing disease. Recurrence after surgical resection is rare. In this case, the local application of retinoic acid ointment after the second operation achieved a good prognosis after 2 years of follow-up. CASE SUMMARY A 76-year-old male patient was admitted to the hospital for "lower lip rupture and scab for 3 mo". Treatment: A rectangular incision was made in the healthy tissue about 3 mm outside the periphery of the lower lip mass, and a modified Bernard sliding flap was designed to completely remove the mass. Pathology showed (lower lip) KA. When the patient returned 6 mo after surgery, the middle mucosa of the lower lip had a bulge with a diameter of about 0.5 cm. The boundary was still clear, the surface was ulcerated. A recurrence of lower lip KA was suspected and a fan-shaped incision was performed in the healthy tissue about 5 mm outside the lesion to completely resect. Pathological showed lower lip KA had recurred. Topical application of tretinoin cream was applied once a day for 3 mo. The lower lip wounds were clean at the 2-year postoperative follow-up and the mucosa was normal. CONCLUSION Adjuvant retinoic acid treatment after KA surgical resection can achieve good results.

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Keratoacanthoma Clinical Behavior

Savage¹,

Maize

2014

The American Journal of Dermatopathology

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As of 2013, keratoacanthomas (KAs) have not been decided on as either a benign or a malignant entity. Originally considered benign epidermal growths, the assertion by Hodak, Jones, and Ackerman that these lesions are truly "an expression of squamous cell carcinoma" (SCC) fueled the controversy and placed some of the biggest names in the field on opposite sides of the issue. Without a clear understanding of the etiology of KAs and without stringent diagnostic criteria, the literature in regard to KA contains scant reports of their "metastatic potential." Four hundred forty-five cases of KA with reported follow-up and outcomes were reviewed from 113 published articles. In our data set, none of these cases resulted in death or distant metastases. When compared with 429 cases of SCC of the skin, with 61 cases of metastases and 24 deaths as a direct result of SCC, the biologic behavior of the 2 entities is distinct and evident. KAs are benign epidermal growths and not a malignant variant of SCC.

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Recurrent keratoacanthoma with vascular invasion: A diagnostic and management dilemma

Cited by 3 publications

References 13 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

Lower lip recurrent keratoacanthoma: A case report

Keratoacanthoma Clinical Behavior

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