Overview
Keratoacanthoma (KA) is a common, rapidly growing, benign epithelial tumor that typically arises on sun-exposed skin. It is characterized by a dome-shaped papule or nodule with a central keratin-filled crater. While generally considered benign, KA can be difficult to distinguish clinically and histologically from squamous cell carcinoma (SCC), necessitating careful evaluation.Diagnosis
Diagnosis is primarily clinical, characterized by rapid growth and a central keratin plug 1.
Histopathological examination is crucial for differentiation from squamous cell carcinoma 1.
Ancillary diagnostic testing in dermatopathology, such as comparative genomic hybridization or fluorescence in situ hybridization, may be considered in specific scenarios, though consensus on appropriateness varies 1.Management
Management options include surgical excision, curettage, cryotherapy, and topical or intralesional therapies 1.
For larger or more aggressive lesions, systemic therapies may be considered 1.
The choice of treatment depends on lesion size, location, patient factors, and the need to rule out malignancy 1.Key Recommendations
Histopathological examination is essential for the diagnosis and differentiation of keratoacanthoma from squamous cell carcinoma 1. (Evidence: Expert opinion)
Ancillary diagnostic testing in dermatopathology should be guided by appropriate use criteria to ensure appropriate test selection for specific clinical scenarios 1. (Evidence: Expert opinion)
Treatment decisions for keratoacanthoma should consider lesion characteristics and the potential for malignancy 1. (Evidence: Expert opinion)References
1 Fung MA, Vidal CI, Armbrecht EA, Andea AA, Cassarino DS, Comfere NI et al.. Appropriate use criteria for ancillary diagnostic testing in dermatopathology: New recommendations for 11 tests and 220 clinical scenarios from the American Society of Dermatopathology Appropriate Use Criteria Committee. Journal of cutaneous pathology 2022. link