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Multiple
keratoacanthomas in a young woman: report of a case emphasizing
medical management and a review of the spectrum of multiple
keratoacanthomas. Int J Dermatol.2007 Jan;46(1):77-9.
A
27-year-old white woman was referred for consultation with regard to
the presence of extensive multiple keratotic lesions. She began to
develop these lesions at the age of 9 years, with healing of the
lesions resulting in scar formation. A biopsy was performed at the
age of 16 years, but the patient was unsure of the results. Since
then, she had not had any treatment or biopsies, and stated that she
had not suffered from any health problems during the intervening
period. She was most concerned about the tumors on her heels and
soles, which caused difficulty with ambulation. The family history
was negative for skin diseases, including melanoma, nonmelanoma skin
cancer, psoriasis, and eczema, and positive for Type II diabetes
mellitus. A relative reported that the patient's grandfather had
similar lesions, but the patient's parents and siblings were
healthy. She was married and had one child, a 9-year-old daughter.
Her child had no skin lesions. The patient's only medication was
Ortho-Tricyclene birth control pills. She had no known drug
allergies. Physical examination revealed the presence of multiple
lesions on her body (Fig. 1). Her left superior helix contained a
well-demarcated, dome-shaped nodule with a rolled, mildly
erythematous border with a central hyperkeratotic plug. A similar
lesion was present in the scaphoid fossa of the left ear and smaller
lesions were scattered on her face. Numerous lesions were present on
the arms and legs bilaterally, with the majority of lesions being
located on the anterior lower legs. There were also lesions present
on the palms and soles. The lesions ranged in size from 5 mm to 3
cm, the largest being a verrucous exophytic nodule on the anterior
aspect of her left leg. Overall, there appeared to be two distinct
types of lesion. One type appeared round, oval, and symmetric with a
central keratotic plug, similar to that on the ear. The other type
was larger, more exophytic, and verrucous, including the lesions on
the volar surfaces. Also present were numerous, irregularly shaped
atrophic scars where previous lesions had healed spontaneously.
There were no oral lesions or lesions on her fingernails or
toenails, and her teeth and hair were normal. A biopsy was obtained
from an early lesion on the right dorsal forearm. Histology revealed
an exo-/endophytic growth having a central crater containing
keratinous material (Fig. 2). The crater was surrounded by markedly
hyperplastic squamous epithelium with large squamous epithelial
cells having abundant glassy cytoplasm. Some cells were dyskeratotic.
Within the dermis was a dense, chiefly mononuclear inflammatory
infiltrate. A buttress of epidermis surrounded the crater. The
clinical and pathologic data were consistent with keratoacanthomas.
Initial laboratory screenings revealed elevated triglycerides and
total cholesterol, 537 mg/dL (normal, < 150 mg/dL) and 225 mg/dL
(normal, < 200 mg/dL), respectively, with all other laboratory
results within normal limits. In anticipation of starting oral
retinoid therapy for her multiple keratoacanthomas, she was referred
to her primary care physician for control of hyperlipidemia. After
her lipids had been controlled, she was placed on isotretinoin (Accutane)
40 mg/day. There was some interval improvement with regression of
some lesions leaving atrophic scars. She was also started on topical
application of tazarotene (Tazorac) for all nonresolving lesions.
Possible side-effects from the isotretinoin occurred, including dry
mouth and eyes. After 8 months of isotretinoin, the patient was
switched to acitretin (Soriatane) 25 mg to determine whether it
might have a more beneficial effect on the resistant lesions. Many
of the larger lesions regressed leaving atrophic scars. The dose of
acitretin was subsequently increased to 35 mg because the lesions on
her heel and the ball of her foot persisted. Almost all of the
lesions resolved, except those on her feet, which are slowly
regressing. Currently, the patient is on a regimen of acitretin 25
mg once a day with tazarotene 0.1% gel applied directly to the few
residual keratoacanthomas on her feet, which are slowly improving.
A case of giant
keratoacanthoma of the auricle. Auris Nasus Larynx. 2000
Apr;27(2):185-8.
Although
keratoacanthomas are not rare in the head and neck area, patients
with this type of tumor rarely consult an otolaryngologists for
treatment. Keratoacanthoma should be considered in the differential
diagnosis of squamous cell carcinoma. This tumor grows rapidly,
usually attaining a size of about 10-20 mm in approximately 6 weeks.
This is followed by slow involution over a period of 2-6 months. A
keratoacanthoma larger than 20-30 mm is called as 'giant
keratoacanthoma' and it is scarce. We encountered a case of giant
keratoacanthoma (50 mm in diameter) on the right auricle of
84-year-old Japanese woman with a 3-year history of gradual tumor
growth. Several clinical and histopathological factors made the
diagnosis difficult. The tumor was completely removed by surgery and
diagnosed as a keratoacanthoma by histopathological examination.
Keratoacanthoma of
the external ear. HNO.1993 Nov;41(11):532-5.
Six hundred
and seventy-eight keratoacanthomas were treated in Hornheide during
the past 30 years. Nearly 10% (67) were located on the auricles. One
patient suffered from two tumors. The records of 8 patients were
lost. Fifty-two of the remaining 59 cases involved males and only 7
patients were female. There was a striking difference between the
sex incidence of the patients with auricular tumors and the overall
total of the keratoacanthomas, with a nearly equal involvement of
both sexes in the latter. The growth time of lesions before
treatment was mostly defined in weeks or even days. The prevalence
increased with age and only 2 patients were younger than 50 years.
Therapy depended on growth stage, tumor diameter and localization.
Therapeutic measurements ranged from excessive surgical treatment to
no treatment. In practise, special dermato-oncologic experience is
necessary for making any decisions concerning the best method of
treatment.
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