The Multiple Growth of Molluscum Sebaceum in Donor and Recipient Sites of Skin Graft

Abstract

OLLUSCUM sebaceum is a common M lesion in South Australia and certainly occurs elsewhere with a greater frequency than the few reports in the literature would indicate. The discrepancy is partially due to the reluctance of many clinicians and pathologists to recognize its separate identity but is mainly the result of indecision in histological differentiation from squamous cell carcinoma so that most of these lesions therefore are not allowed to prove their benign habit by being left to disappear spontaneously. FIG. I. Shows large lesion on the radial edge of the graft, with the two other smaller lesions on the proximal and ulnar borders.The following case of a patient with multiple skin lesions over many years is of interest because of the appearance of typical growths of molluscum sebaceum around the donor and recipient sites of skin grafts following removal of two "squamous cell carcinomas" of the back of the hand. This resulted in clinical diagnosis of malignant recurrence at the original site, and of operative implantation on to the donor area. CASE REPORTThe patient, a man aged 76, had been attending the Radiotherapy Uepartment for twelve years with multiple and recurrent skin tumours of various parts of the dorsum of both hands which had been treated by surgery and irradiation. He presented in October, 1953, with two red nodules which had grown in two months on the right hand. One was in the midst of a scar of a previous lesion, healed following radiation therapy, on the dorsum of the hand; it measured 1.5 cm. in diameter. The other was a smaller lesion over the head of the fifth metacarpal bone and measured just over a centimetre in diameter. Both , had bulging smooth raised edges and a central crust. These two lesions were excised, that on the back of the hand being removed (to include the scar of the previous treatment) with a large area of surrounding skin, which was approximately oval and measured 8 x 5 cm. The deficiencies were covered by split skin grafts taken from the right thigh. The pathologist reported on the two lesions as welldifferentiated squamous cell carcinomas. FIG. 11. Biopsy from the edge of the large lesion shown in Fig. I. (x 6.5)The grafts took well, but two months later the patient returned with further lumps, 3 on the donor site on the right thigh and 3 on the recipient site on the dorsum of the right hand. Those on the right hand (Fig. I ) were all on the junction of the graft with the native skin, measuring 1.3 cm., 0.8 cm. and 0.5 cm. in diameter respectively. The lesions were raised, rounded, smooth nodules, the largest being tomato-red and having a central horny plug suggestive of molluscum sebaceum. The small graft over the head of the metacarpal bone showed

Keratoacanthoma formation after skin grafting: A brief report and pathophysiological hypothesis

“…Only two cases of multiple KA developing at both STSG donor and recipient sites have been reported in the existing literature . Similarities among the three cases (including this one) were primarily the patient's age, the location of the KA and the treatment response.…”

“…Two cases demonstrated KA with a high recurrence rate despite rigorous treatment (including topical chemotherapy and surgery), but responded well to acitretin . While some KA spontaneously involuted in the third case, some of his KA did not and were resistant to radiation therapy …”

“…In current practice, systemic retinoids are generally reserved for cases of multiple or refractory KA . We recommend early consideration of systemic retinoids in patients with postoperative KA as they tend to be multiple and treatment resistant . A wait‐and‐watch approach should be avoided unless there are clear signs of involution, as spontaneous regression has been inconsistently observed .…”

“…We recommend early consideration of systemic retinoids in patients with postoperative KA as they tend to be multiple and treatment resistant . A wait‐and‐watch approach should be avoided unless there are clear signs of involution, as spontaneous regression has been inconsistently observed . Given their increased tendency to koebnerise, surgical excision of KA requires careful deliberation.…”

Traumatic Keratoacanthoma Arising in a 15‐Year‐Old Boy Following a Motor Vehicle Accident

“…Since that time, approximately 47 other patients, with 49 examples of traumatic KA, have been reported in the literature. Their ages ranged from 34 to 82 years (2,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). The time interval between the traumatic event and the appearance of the KA varied from 1 week to 1 year (2,7-26).…”