Solitary Keratoacanthoma Is a Squamous-Cell Carcinoma

Hodak, Emmilia; Jones, Robert E.; Ackerman, A. Bernard

doi:10.1097/00000372-199308000-00007

Cited by 225 publications

(161 citation statements)

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“…27 This has led to the controversy over whether keratoacanthoma is a distinct entity or a variant of cutaneous squamous cell carcinoma. 3,27 Several studies proposed different criteria to distinguish keratoacanthoma from squamous cell carcinoma. Cribbier et al 5 based their study on histological criteria and concluded that the distinction is impossible on histological criteria alone.…”

Section: Discussionmentioning

confidence: 99%

Biological behavior of keratoacanthoma and squamous cell carcinoma: telomerase activity and COX-2 as potential markers

2004

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Distinguishing keratoacanthoma from squamous cell carcinoma is a persistent issue in pathology practice. Solitary keratoacanthoma is a self-limiting lesion as opposed to rather aggressive clinical behavior of squamous cell carcinoma. Several markers were studied to understand their biology and to separate these two lesions on a firm basis, but without much success. In this study, we plan to utilize recent markers such as telomerase activity and cyclooxygenase-2 (COX-2) along with more established marker p53 in understanding the biologic differences between keratoacanthoma and squamous cell carcinoma. We studied 17 well to moderately differentiated squamous cell carcinoma and 24 early proliferative phase keratoacanthoma by immunohistochemistry for the expression of p53 protein, COX-2 and telomerase activity. Higher telomerase activity was found in 11/17 squamous cell carcinoma (65%) compared to 4/24 (17%) of keratoacanthoma. Similarly, stronger expression of p53 and COX-2 was detected in 12 (71%) and 11 (65%) cases of squamous cell carcinoma compared to 2 (8%) and 2 (8%) cases of keratoacanthoma respectively. A highly significant 'P ' value was obtained for telomerase activity (0.001), p53 (0.000), and COX-2 (0.001). Telomerase activity, COX-2, and p53 expression provide evidence that keratoacanthoma and squamous cell carcinoma are indeed distinct entities and also help in discriminating these two lesions, which closely resemble each other on conventional morphology. Although these markers present new insights into the biologic variation of keratoacanthoma and squamous cell carcinoma, they are of limited value for routine application in histological distinction of these two lesions. The differential expression of markers also explains the sustained proliferation observed in squamous cell carcinoma, compared to a shorter lifespan and involution in keratoacanthoma.

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Section: Discussionmentioning

confidence: 99%

Biological behavior of keratoacanthoma and squamous cell carcinoma: telomerase activity and COX-2 as potential markers

2004

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“…KAs can easily be mistaken for SCC as clinical presentation and histopathologic findings are very similar. Some authors regard KA as a variant of SCC 8 . Others believe they are different since Kas, as a group, display unique clinico-pathological features.…”

Section: Discussionmentioning

confidence: 99%

Conjunctival keratoacanthoma

et al. 2004

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Keratoacanthoma generally occurs on the skin; it is rarely found in the conjunctiva. A case of a 34-year-old woman with a rapidly growing conjunctival mass is reported. The tumor was excised with a safety margin to exclude squamous cell carcinoma. Histopathologically it was crateriform and consistent with atypical keratoacanthoma. There has been no recurrence in 2 years of follow-up. Conjunctival keratoacanthoma is rare; differential diagnosis of conventional squamous cell carcinoma and keratoacanthoma can be difficult. We recommend complete surgical excision and careful follow-up of crateriform squamous proliferations.

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“…1,3 Differential diagnosis between keratoacanthomas and well-differentiated squamous cell cancers (SCCs), based on clinical and histomorphological data, may be problematic and there are some reports on lesions classified as keratoacanthoma that have metastasized. 4 It is thought that those keratoacanthomas of sun-exposed locations and diagnosed in older patients may more frequently progress to SCC. 5 Some authors believe that keratoacanthoma is a well-differentiated variant of SCC representing a range of neoplastic activity with no clear distinction, whereas some authors consider the histological and cytological differentiation precise, sure, and possible.…”

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confidence: 99%

Transformation-specific matrix metalloproteinases, MMP-7 and MMP-13, are present in epithelial cells of keratoacanthomas

et al. 2006

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Keratoacanthomas are rapidly growing hyperproliferative skin tumors that may clinically or histologically be difficult to distinguish from well-differentiated squamous cell cancers (SCCs). UV light, trauma, and immune suppression represent their etiological factors. As matrix metalloproteinases (MMPs) are implicated at all stages of tumorigenesis, we investigated the expression profile of several cancer-related MMPs to find markers that would differentiate keratoacanthomas from SCCs and shed light to the pathobiology of keratoacanthoma. Samples from 31 keratoacanthomas and 15 grade I SCCs were studied using immunohistochemistry for MMP-2, -7, -8, -9, -10, -13, and -19 and p16 and laminin-5c2 chain. In situ hybridization for MMP-7, -10, and -13 was performed in a subset of tumors. Keratinocytes with atypia, presence of neovascularization, and composition of the inflammatory infiltrate were graded from hematoxylin-eosin stainings. MMP-7 was present in the epithelium of 4/31 keratoacanthomas and 9/15 SCCs, MMP-8 in 3/30 keratoacanthomas and 0/15 SCCs, but MMP-13 in 16/31 keratoacanthomas and 10/15 SCCs, and MMP-10 in 28/31 keratoacanthomas and all cancers. MMP-9 was detected in the epithelium in 5/31 keratoacanthomas and 8/15 SCCs, whereas MMP-2 was only present in fibroblasts in both tumors. MMP-19 was upregulated in proliferating epithelium of keratoacanthomas as was p16. Cytoplasmic laminin-5c2 was particularly abundant in keratinocytes at the pushing border of MMP-13-positive keratoacanthomas. We conclude that although some MMPs (MMP-10 and -13) are abundantly expressed in keratoacanthomas, the presence of MMP-7 and -9 in their epithelial pushing border is rare and should raise suspicion of SCC. Further, the loss of MMP-19 and p16 could aid in making the differential diagnosis between well-differentiated SCC and keratoacanthoma. Frequent expression of the transformationspecific MMP-13 in keratoacanthomas suggests that they are not benign tumors but incomplete SCCs.

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Solitary Keratoacanthoma Is a Squamous-Cell Carcinoma

Cited by 225 publications

References 0 publications

Biological behavior of keratoacanthoma and squamous cell carcinoma: telomerase activity and COX-2 as potential markers

Biological behavior of keratoacanthoma and squamous cell carcinoma: telomerase activity and COX-2 as potential markers

Conjunctival keratoacanthoma

Transformation-specific matrix metalloproteinases, MMP-7 and MMP-13, are present in epithelial cells of keratoacanthomas

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