Call Us Today:
949.200.1600

SCC Keratoacanthoma Type

Home > Diagnosis > Squamous Cell Carcinoma > SCC Keratoacanthoma Type

Skin-Cancer-Specialists-Squamous-Cell-Carcinoma-Keratoacanthoma-Skin-Cancer-And-Reconstructive-Surgey-Center-Orange-County

About SCC Keratoacanthoma Type

Keratoacanthoma has been described as a benign lesion that spontaneously involutes and as a variant of squamous cell carcinoma that rarely can behave aggressively. We present a case of a keratoacanthoma-like lesion in an elderly patient that recurs invading deeply into vital structures.

Diagnosis

The diagnosis of a classic keratoacanthoma (KA) is based on clinical and histologic findings. Clinically, the classic KA appears as a nodule with a central keratin-filled crater. It has three phases of behavior:


(1) a proliferative phase of 2–10 weeks,
(2) a stationary period of 2-10 weeks, and
(3) an involution phase of up to one year duration.

 

KA has distinct histological features of keratin-filled crater lined by a proliferating squamous epithelium. Shave or incisional punch biopsies are usually inadequate to diagnose keratoacanthoma, and the definite diagnosis can only be established after tumor excision, based on the histological findings.

Treatment

Treatment of classic keratoacanthomas can be conservative given their self-limiting course and has included curettage and intralesional methotrexate.

 

The catch with KA is the association with squamous cell carcinoma (SCC) and occasional aggressive behavior. 16.7% of KA are SCC. This speaks to the significant overlap in the clinical and histological appearance of the two, which can result in misdiagnosis of SCC as KA. In addition, KA may coexist with a SCC in the same lesion, as the more aggressive cell line eventually transforms the tumor into an aggressive lesion. The development of SCC in a KA has been reported in 5.7% of KA’s. In patients older than 90 years, the transformation incidence was found to be almost 14%.

 

Metastases with KA’s are very rare even with evidence of perineural invasion. It has been suggested that perineural invasion in KA’s is less significant than in SCC.

 

Treatment of keratoacanthomas is surgery. Mohs surgery is the standard with a reported recurrence rate of 2.4%. Radiation including orthovoltage has been shown to be highly effective as well.

 

Read case study here.

 

References:
Petrie, et al. Keratoacanthoma of the Head and Neck with Perineural Invasion. Dermatol Surg 2010; 36:7: 1209-1213
Donohue, et al. Treatment of aggressive keratoacanthomas by radiotherapy. J Am Acad Dermatol 1990; 23:3: 489-493.
Larson. Keratoacanthomas treated with Mohs’ micrographic surgery. J Am Acad Dermatol 1987; 16:5: 1040-1044.
Caccialanza, et al. Radiation therapy of keratoacanthomas: results in 55 patients. Int J of Radiat Oncol Biol Phys 1989; 16:2: 475-477.
Mandrell, et al. Keratoacanthoma: hyperplasia, benign neoplasm, or a type of squamous cell carcinoma? Semin in Diagnost Pathol 2009; 26:3: 150-163.
Donaldson, et al. Periocular keratoacanthoma. Ophthalmology 2003; 110:7: 1403-1407.

SCC-Scalp-Newport-Beach-Mohs-and-Reconstruction-perineural-invasion
SCC of Scalp
HISTORY 86-year-old man presents with 3-month history of a mass in the left occipital scalp. 1 year prior, the patient underwent Mohs excision of a large scalp SCC.  FNA biopsy on 1-22-18 found atypical squamous cells. CT PET scan showed cancer limited to the mass itself with no lymph node enhancement. Patient experienced progressively increasing…
Read More
Dysplasia-lower-lip-actinic-cheilitis-skin-cancer-SCC
Dysplasia of Lower Lip
HISTORY 51-year-old man presents with one-year history of lower lip nonhealing lesion. The patient has a many year history of extensive sun exposure with scaling and crusting.  A biopsy of the nonhealing lesion showed leukokeratosis with minimal keratinocytic atypia. Excisional biopsy done 11-1-17 showed moderate to focally severe squamous atypia. The patient was then treated…
Read More
Treatment for Multiple Skin Cancer Patients
Multiple Skin Cancers in an Organ Transplant Recipient
HISTORY 71-year-old organ transplant recipient presents with several SCC’s of scalp and face. Mohs excisions and closures were performed.  Tissue of the left temple incidental to reconstruction was submitted for histologic analysis. Incidental BCC was found in the specimen requiring additional treatment. 4 to 6 o’clock margin was involved.   The patient with bilateral kidney…
Read More
Recurrent-SCC-of-Nasal-Tip-Orange-County-Skin-Cancer
Recurrent SCC of Nasal Tip
HISTORY 71-year-old man presents with recurrence of SCC of left nose. Mohs excision of left nasal tip SCC was performed on 2-9-17. Left nasal fullness under flap, initially thought to be a scar, progressed until drainage appeared. Pathology of draining debris under flap showed invasive squamous cell carcinoma.  Intranasal mapping biopsies were performed on 2-12-18.…
Read More
Skin-Cancer-And-Reconstructive-Surgery-Foundation-Forehead-SCC-with-perineural-invasion-Beam’s-eye-view
Forehead SCC with Perineural Invasion
HISTORY   83-year-old man presented in 02/2017 with a 3-year history of a forehead and temple SCC. The cancer was initially treated with cryoablation and 5-FU. Excision on 9/2/16 was performed with residual circumferential margins. Histology found poorly differentiated sclerosing squamous cell carcinoma, with perineural invasion of 0.1 mm nerves.  Wide local resection with radial…
Read More
Skin-Cancer-And-Reconstructive-Surgery-Foundation-Scalp-SCC-Metastasis-to-neck-CT-PET-scan
Scalp SCC Metastasis to Neck
HISTORY   64-year-old man presents in 11/2017 with tender, right postauricular swelling. Fine needle aspiration biopsy showed squamous cell carcinoma. Extensive squamous cell carcinoma of scalp was treated with 4 levels of Mohs earlier that year in 01/2017. Additional smaller squamous cell carcinoma of the same area of the scalp was treated with Mohs in…
Read More

STAY UP TO DATE

Receive research updates, inspiring stories, healthy living tips and more.

Something went wrong. Please check your entries and try again.

FOLLOW US

ELEVATING THE STANDARDS OF SKIN CANCER MANAGEMENT.

© 2018 SCARS Management Services. All rights reserved.