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.

Intralesional 5-fluorouracil for Cutaneous BCC and SCC
HISTORY  An 86-year-old man on hemodialysis with multiple medical problems and on warfarin presented with two carcinomas of the nasal tip: BCC of the left nasal tip and SCC of the right nasal tip. The ulceration of the right SCC exposed the alar cartilage. Patient completed six (6) 5-fluorouracil injections over a 5-week period. Complete…
Read More
Sentinel Lymph Node Biopsy for Cutaneous SCC
HISTORY A 58-year-old kidney transplant recipient presented with a 6-month history of squamous cell carcinoma of the left scalp. This large lesion was adjacent to the scar of a previous carcinoma excision in 2014. Patient is on sirolimus for his kidney transplant performed in 1984. He has had multiple BCCs and SCCs of scalp, back,…
Read More
Lethal Squamous Cell Carcinoma of the Forearm in a Lung Transplant Recipient
HISTORY A 71-year-old lung transplant recipient presented with a recurrence of left dorsal forearm and wrist Squamous Cell Carcinoma (SCC) after Mohs excision in 2016 performed elsewhere. The patient underwent Mohs excision with clear margins and additional deeper wide local resection with no carcinoma identified. Patient was referred for radiation oncology evaluation, but he was…
Read More
recurrent-bowens-disease-squamous-cell-carcinoma-topical-chemotherapy
Recurrent Bowen’s Disease of Temple
HISTORY 63-year-old man presents with 9-month history of Bowen’s disease of right anterior and posterior sideburn biopsied on 08-20-18. History of previous Mohs excision of Bowen’s disease of the same area in February 2016. Patient has a history of multiple basal cell carcinomas, squamous cell carcinomas, and melanoma. DISCUSSION Management of this lesion is best…
Read More
cystic-squamous-cell-carcinoma-of-forearm-keratoacanthoma-dermatopathology
Cystic Squamous Cell Carcinoma of Forearm Skin
HISTORY 74-year-old man presents with 3-month history of painful lesion of the right forearm.  Biopsy found cystic squamous cell carcinoma with deep margins involved. Wide local excision was performed achieving clear margins. DISCUSSION Cystic degeneration within squamous cell carcinoma of the skin is not considered an especially malignant finding. These histologic findings may represent changes…
Read More
anticoagulant-use-in-cutaneous-surgery-scalp-squamous-cell-carcinoma-Mohs-and-reconstruction
Anticoagulant Use in Cutaneous Surgery
HISTORY 87-year-old man with atrial fibrillation presented with squamous cell carcinoma in situ of scalp and forehead. Patient was treated with Mohs and reconstruction on 7-3-18. Incisional hematomas appeared 2.5 weeks post Mohs and treated with I&D. Patient continued warfarin and baby aspirin throughout treatments. DISCUSSION Anticoagulant use in Facial and Dermatologic Surgeries has become…
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.