What is Keratoacanthoma?
Keratoacanthoma is a low-class malignant skin condition. This condition is pretty common in the elderly (60 years old and above). Some studies that was conducted to reveal the definitive facts of Keratoacanthoma,shows that it starts at the hair follicle. This condition strongly resemble a similar skin condition called squamous cell carcinoma because of this pathologist consider it as a different kind of squamous cell carcinoma becauseaccording to doctors who handle this kind of patient, if keratoacanthoma is left untreated it will proceed to squamous cell carcinoma. Although rarely, the condition can proceed to metastatic skin carcinoma, a form of skin carcinoma that can spread to other organs. If this is the case, in the mere presence of keratoacanthoma, doctors will implement aggressive intervention just to be in the safe side and to prevent complications. Amazingly, in some patients, there are no complications when keratoacanthoma is left untreated.
Unlike other skin conditions, it cannot be diagnosed by just submitting a small portion of the Keratoacanthoma lesion to the pathologist. A real diagnosis is only made when the whole structure of the lesion is submitted. In this case, there will be a difference on the clinical diagnosis or the initial assessment of the lesion and the pathologic diagnosis made by a pathologist.
Most of the time, it grows in an area that is exposed to the sun, this includes the face, the neck, the arms, and parts of the dorsum. Generally, the colour of the lesion is pinkish to red. The lesion is at the center and it forms a circle, the lesion is black in colour. According to the patients who are affected with the condition, pain is present at the site of the lesion. I have listed some of the key characteristics of the condition.
Here is the list of key characteristics of Keratoacanthoma:
- Shaped like a dome.
- Symmetrical in shape.
- There is a wall of inflamed skin that surrounds the lesion.
- It has scales at the top of the lesion.
The exact causes of Keratoacanthoma is not well defined, however, the most common factor is age; an elderly person is prone to develop skin tumours because of the skin fragility to sun and other chemicals. And just like other malignant skin condition, Keratoacanthoma can be caused by excessive exposure to ultraviolet light that came from the sun. Exposure to the sun is considered the most important causative factor for this condition. Some other cases suggest that it originated from a Human Papilloma Virus (HPV), but this hypothesis is not yet proven to be true for all cases.
- Genes and Family History– These factors are very important in determining the underlying cause of Keratocanthoma. The tests suggest that this condition might be connected to the chromosomal variations.
- Smoking– It is a factor in developing the condition, according to a 2006 study.
- Immunocompromised– Although unclear, this was implicated and tested as another cause for developing Keratoacanthoma.
Since the lesion is local and superficial, Skin biopsy is a definitive way to know if the skin condition is Keratoacanthoma. Shave biopsy is not an option because this only uses the debris from the lesion and the specimen will not be able to give a definitive diagnosis to this condition. The preferred biopsy is an incisional biopsy that is because it uses the lesion itself and this gives the definitive diagnosis for Keratoacnthoma.
- Incisional Skin Biopsy– It is a procedure to extract sample cells from the lesion to see if the lesion will proceed to squamous cell carcinoma.
Treatment of Keratoacanthoma
Treatment is mostly surgical, if the patient preferred surgery, Mohs Surgery is often used. This is a surgical procedure that uses a narrow surgical margin to produce an excellent cure rate, but does not compromise the patient’s other organs. It is possible because it is a surgery in the microscopic level that enables minimal tissue removal. But there is a way to treat the condition if a surgery is unwanted or if the patient cannot undergo a surgical procedure. If the patient preferred non-surgical method, these are the treatment options that are available for the patient:
Drugs such as Bleomycin, Methotrexate, and 5-Fluorouracil can be used to stop the proliferation of the cancerous cells. One disadvantage of these drugs is the systemic effect of the drug. (e.g. hair loss)
Skin Lesion Management
Doctors prefer Retinoids to treat the lesions. This therapy is also used for patients with severe acne.
Prognosis of Keratoacanthoma
The prognosis is good for patients who undergone surgery. However, there are also recurrent tumours, in this case, patient should take action and it would require an aggressive intervention.
Keratoacanthoma In the Nose
Keratoacanthoma in the Lips
Keratoacanthoma in the Hands
Keratoacanthoma in the Eye Lid
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