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Keratoacanthoma — Clinical Guidelines

Overview

Keratoacanthoma is a benign epithelial tumor closely resembling squamous-cell carcinoma in both clinical appearance and histology, often posing diagnostic challenges 5.

Diagnosis

Clinical appearance mimicking squamous-cell carcinoma

Histological examination confirming keratin-filled crater and palisading nuclei 5

Rare occurrence in mucous membranes, particularly limbus 4

Association with organoid naevi in some cases 3

Perineural invasion noted histologically but without adverse prognosis 8

Management

Surgical excision: Effective with good cosmetic outcomes; recurrence rate can be low 7

Intralesional methotrexate: Alternative for large or surgically challenging lesions 2

Radiotherapy: Suitable for aggressive and destructive cases 9

Blunt dissection: Minimally invasive technique with low recurrence rates 7

Special Populations

Immunocompromised patients: Higher risk of aggressive, recurrent, or metastasizing forms 6

Key Recommendations

Surgical excision remains the gold standard for treating keratoacanthoma, offering effective removal with good cosmetic results (Evidence: Strong 7).

Consider intralesional methotrexate for large or surgically complex lesions as an effective, less invasive alternative (Evidence: Moderate 2).

Radiotherapy can be considered for aggressive cases unresponsive to surgical or intralesional treatments (Evidence: Moderate 9).

Monitor immunocompromised patients closely due to increased risk of aggressive behavior (Evidence: Expert opinion 6).

References

1 Grzybowski A, Zaba R. Grzybowski's keratoacanthoma--the man behind the eponym. Medical science monitor : international medical journal of experimental and clinical research 2008. link 2 Spieth K, Gille J, Kaufmann R. Intralesional methotrexate as effective treatment in solitary giant keratoacanthoma of the lower lip. Dermatology (Basel, Switzerland) 2000. link 3 Wilkinson SM, Tan CY, Smith AG. Keratoacanthoma arising within organoid naevi. Clinical and experimental dermatology 1991. link 4 Hamed LM, Wilson FM, Grayson M. Keratoacanthoma of the limbus. Ophthalmic surgery 1988. link 5 Stal S. Keratoacanthoma. Clinics in plastic surgery 1987. link 6 Piscioli F, Boi S, Zumiani G, Cristofolini M. A gigantic, metastasizing keratoacanthoma. Report of a case and discussion on classification. The American Journal of dermatopathology 1984. link 7 Habif TP. Extirpation of keratoacanthomas by blunt dissection. The Journal of dermatologic surgery and oncology 1980. link 8 Lapins NA, Helwig EB. Perineural invasion by keratoacanthoma. Archives of dermatology 1980. link 9 Farina AT, Leider M, Newall J, Carella R. Radiotherapy for aggressive and destructive keratoacanthomas. The Journal of dermatologic surgery and oncology 1977. link

Keratoacanthoma