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What Is Squamous Cell Carcinoma Keratoacanthoma Type

Does Squamous Cell Carcinoma Go Away On Its Own

Excision of a skin cancer, a keratoacanthoma, filmed with my GoPro

They may go away on their own and come back. You should call your doctor if you notice a change in the color, texture, or appearance of your skin or if you have a sore that does not heal or bleeds. Your doctor can diagnose squamous cell carcinoma by examining the growth and performing a biopsy of the suspected area.

What Is The Prognosis Of Keratoacanthoma

The prognosis for keratoacanthoma is excellent following excisional surgery. Recurrent tumors may require more aggressive therapy. Follow patients with a history of keratoacanthoma for development of new primary skin cancers . It has been reclassified as SCC-KA type to reflect the difficulty in histologic differentiation. Uncommonly, keratoacanthomas may exhibit an aggressive growth pattern. Keratoacanthoma infrequently presents as multiple tumors and may enlarge , become aggressive locally, or rarely, metastasize.

Waiting For The Biopsy Result

Wait. And wait. Waiting has been a big part of my skin cancer story. As I waited my tumor grew. Protruding off my forehead was an angry red volcano with a yellow crater in the center. It was still smaller than a dime, but much bigger than the original red bump. I was nervous and worried.

Finally almost 10 days after the shave biopsy I hear the news that it is squamous cell carcinoma. Im beyond relieved when they schedule me for Mohs surgery four days later. It took two passes of Mohs surgery to get clear margins and I learn my tumor was called a keratoacanthoma. I was grateful to have it removed and I was ready to put it behind me .

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What Are The Signs And Symptoms Of Keratoacanthoma

The signs and symptoms of Keratoacanthoma include:

  • It occurs as a well-formed nodule and is usually solitary in nature
  • The size of the lesions range from 1-2 cm
  • They grow rapidly, then stabilize in size and start to disappear
  • It may ulcerate and bleed
  • In some cases, the tumor may appear more pigmented than the surrounding skin
  • Keratoacanthomas are observed on sun-exposed areas that include the face, arms, and legs

Optimal Therapeutic Approach For This Disease

Keratoacanthoma (Squamous cell carcinoma of the ...

Management depends on the type of keratoacanthoma, the location, and the number of lesions.

Solitary keratoacanthomas: primary excision, Mohs micrographic surgery.

  • If anatomically sensitive area , Mohs surgery.

  • Alternate treatment options for solitary keratoacanthomas: electrodessication and curretage

Large tumors in sensitive location not amenable to surgery or keratoacanthoma marginatum:

  • Intralesional methotrexate

  • Intralesional 5-fluorouracil:

For large tumors where excision may result in a cosmetic deformity or in patients who are not surgical candidates, consider radiation therapy.

Multiple keratoacanthomas have responded in one patient to intralesional 5-fluorouracil, 10-20mg per treatment for 7 weeks yielded 100% response in one patient with fourteen tumors.

Generalized eruptive keratoacanthomas or multiple keratoacanthomas: options include systemic administration of retinoids, isotretinoin, , acitretin, . Cyclophoshpamide has also been used .

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What Are The Symptoms Of Keratoacanthoma

The symptoms of KA are visual and lasts two to three months. The look is often compared to a small volcano.

First, KA shows up as small, round bump. Then, it grows into a lesion or wound and reaches a size of between 1 and 2 centimeters within a few weeks. The wound looks like a dome with a plug made of brown keratin, which is the same material as hair and skin.

If the brown keratin comes out, the KA will look like a crater. When it heals, itll flatten and leave a scar.

The exact cause of KA is unknown. Some factors that may contribute to getting KA are:

  • sun exposure

What Is The Evidence

Nofal, A, Assaf, M, Ghonemy, S, Nofal, E, Yosef, A. âGeneralized eruptive keratoacanthoma: a diagnostic and therapeutic challengeâ. Int J Dermatol. vol. 29. 2014 Jul.

Aydin, F, Senturik, E, Sabanciler, E. âA case of Ferguson-Smith type multiple keratoacanthomas associated with keratoacanthoma centrifugum marginatum: response to oral acitretinâ. Clin and Exp Dermatol. vol. 32. 2007. pp. 683-686.

Batinac, T, Zamolo, G, Coklo, M. âExpression of cell-cycle and apoptosis regulatory proteins in keratoacanthoma and squamous cell carcinomaâ. Pathol Res Pract. vol. 202. 2006. pp. 599-607.

Clausen, OP, D.Aass, HC, Beigi, M, Purdie, KJ, Proby, CM, Brown, VL. âAre keratoacanthomas variants of squamous cell carcinomas? A comparison of chromosomal aberrations by comparative genomic hybridizationâ. J Invest Dermatol. vol. 16. 2006. pp. 2308-2315.

Dendorfer, M, Oppel, T, Wollenberg, A. âTopical treatment with imiquimod may induce regression of facial keratoacanthomaâ. Eur J Dermatol. vol. 13. 2003. pp. 80-82.

Goldberg, LH, Rosen, T, Becker, J. âTreatment of solitary keratoacanthomas with oral isotretinoinâ. J Am Acad Dermatol. vol. 23. 1990. pp. 934-936.

Grey, RJ, Meland, NB. âTopical 5-fluorouracil as primary therapy for keratoacanthomaâ. Ann Plast Surg. vol. 44. 2000. pp. 82-85.

Grine, RC, Hendrix, JD, Greer, KE. âGeneralized eruptive keratoacanthoma of Gryzbowski: response to cyclophosphamideâ. J Am Acad Dermatol. vol. 36. 1997. pp. 786-787.

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Summary Of Multiple Keratoacanthoma Variants

The multiple keratoacanthoma variants are summarized in Table I.

Table I.
Multiple eruptive keratoacanthomas of GryzbowskiMultiple keratoacanthomas of Witten and ZakFerguson Smith type
Autosomal dominant 9q22-q31Two large Scottish kindreds
Age of onset
Crops of keratoacanthomas, few to hundreds
CoursePossible ectropion and masked faciesMixed eruptive and self healing

Appear suddenly, involute, and then reappear.

Are You Confident Of The Diagnosis

Is it really an SCC? How to spot a Keratoacanthoma

Keratoacanthomas closely resemble squamous cell carcinomas. Many observers consider them to be low-grade squamous cell carcinomas. There is much debate in the literature about the relationship of these two entities. They are clinically distinguished by the initial rapid growth of a keratoacanthoma, stabilization, and frequent spontaneous regression, as contrasted with squamous cell carcinomas.

  • Characteristic findings on physical examination

Findings include a firm dome-shaped nodule with a central keratin filled crater .

Figure 1.

Classic keratoacanthoma.

Figure 2.

Giant keratoacanthoma.

Figure 3.

Giant Keratoacanthoma.

Figure 4.

Low magnification of a keratoacanthoma showing an endophytic crateriform neoplasm.

Figure 5.

A different example, showing an endophytic cup-shaped tumor.

  • Expected results of diagnostic studies

Histopathology shows a central keratin-filled crater with a lip of epithelium extending over the edges of the lesion. There is usually a sharp demarcation between tumor nests and stroma. Proliferating keratinocytes often display glassy eosinophilic cytoplasm with mild cytologic atypia and mitoses. A perivascular or lichenoid infiltrate with lymphocytes, occasional eosinophils, and plasma cells may be seen .

Figure 6.

Intradermal islands of pleomorphic keratinocytes at the base of the tumor.

Figure 7.

Intradermal tumor islands extend to the level of eccrine glands and may incorporate neutrophils.

Figure 8.
Figure 9.
  • Diagnosis confirmation

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Is Keratoacanthoma Serious

Its a non-melanoma skin cancer that rarely metastasizes, meaning it wont spread to other areas of the body. But it can still be dangerous and should be treated by a doctor. Many people with one KA lesion may develop more throughout their lifetime. But several rare conditions can cause multiple KAs to appear at once.

Three Weeks Is A Long Time

Fortunately I was able to get a Mohs surgery scheduled at Mayo Clinic exactly three weeks after discovering the cancer was back. It seems pretty quick looking back, but at the time the wait was scary and long. In three weeks the tumor had grown from the size of a dime to about an inch in diameter!

It took three passes of the Mohs surgery to get it all. The tumor had grown under the nerve that controls my eyebrow and that nerve was removed during the surgery. I was grateful that I did not lose part of my eyebrow also as the tumor had grown quite close to it. After the surgery was completed, the hole in my skin was the size of an egg. I was then scheduled for surgery under anesthesia the next day to close the wound, permanently fix my eyebrow to a neutral position, and also do a lymph node biopsy. My husband and I went to our hotel that night numb with shock. I hadnt expected to need a surgery under general anesthesia and I hadnt expected a lymph node biopsy or losing the nerve that controls my eyebrow. The whole experience felt unreal.

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Should Keratoacanthoma Be Removed

Its not unusual for a single keratoacanthoma to shrink and disappear on its own after several months. But it may leave a worse scar than one from surgery. It could also come back, so its best to get it removed. If you dont treat it, keratoacanthoma can spread throughout your body.

Sharing My Story Of Keratoacanthoma Recurrence

Keratoacanthoma (Squamous cell carcinoma of the ...

I wanted to share my story as I have not heard of another one like it and hope my story can help someone else. In spite of all I went through, I feel fortunate. I am so grateful for the support of my husband and kids, other family members and friends. There has not been another skin cancer recurrence so it appears I do not have the rare type of keratoacanthoma. As the months pass the wound is less noticeable and can be covered with makeup and my hair. My goal to make myself healthier than ever. I am working to reduce my stress levels through prayer, meditation and yoga and improve my health through better eating habits and continued exercising. Currently, I see my doctors every 3 months for follow-ups and I monitor my own skin for changes as well. I have much to be thankful for.

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‘global Surgery’ In Low

Surgery remains grossly neglected in global health, famously described by as the ‘neglected stepchild of global health’. This particularly affects low-resource settings with weak surgical health systems. ‘Global surgery’ is the term now adopted to describe the rapidly developing field seeking to address this, and has been defined as ‘the multidisciplinary enterprise of providing improved and equitable surgical care to the world’s population, with its core tenets as the issues of need, access and quality’.

In 2014, Commission on Global Surgery was launched to examine the case for surgery as an integral component of global health care and to provide recommendations regarding the delivery of surgical and anesthesia services in low and middle income countries. In this study, two primary conclusions were reached:

  • Five billion people worldwide lack access to safe, timely, and affordable surgical and anesthesia care. Areas in which especially large proportions of the population lack access include Sub-Saharan Africa, the Indian Subcontinent, Central Asia and, to a lesser extent, Russia and China. Of the estimated 312.9 million surgical procedures undertaken worldwide in 2012, only 6.3% were done in countries comprising the poorest 37.3% of the world’s population.
  • An additional 143 million surgical procedures are needed each year to prevent unnecessary death and disability.

Data Of Histopathological Diagnosis Of Lesions Clinically Diagnosed As Ka

Ansai, the co-author, reported the histopathological diagnosis of 1527 patients who were clinically diagnosed with KA at a Japanese institution . Those lesions were most frequently located on the face . In 999 patients , the histopathological architecture of KA was observed . The mean age at resection of the KA lesion was significantly higher for these patients than for those without KA histopathological architecture . In sun-exposed areas, the rate of KA lesions was high 28.5% of the patients had malignant neoplasms, including SCC, especially patients over 60 years old, and 39.0% of cases were malignant. The rate of malignant lesions was higher in sun-exposed areas in elderly patients. The mean age at resection of malignant lesions was significantly higher than that for benign lesions . The 1527 cases included 1397 epithelial tumors 99 non-epithelial tumors , and 31 inflammatory lesions . Based on our impression, clinical differential diagnosis of crateriform epithelial tumors is very difficult. We consider that there is no certain clinical feature that differentiate benign crateriform tumors, especially solitary KA, from malignant ones, other than clinical course of the lesion, although CFV that is frequently observed benign crateriform tumor, shows long-standing course. Based on these findings, lesions clinically suspected as KA should be totally resected as soon as possible, especially on the faces of elderly patients.

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A Squamous Cell Carcinoma Diagnosis

In the fall of 2016, I scheduled a skin cancer check because it had been three or four years since my last visit. About two weeks before my already scheduled appointment I noticed a red pimple on my forehead. It was red and tender like a pimple but did not respond to any of my regular acne treatments. At my appointment I asked about it and they decided to do a shave biopsy. I wasnt too concerned until about 5 days after the biopsy when I took off the band-aid and saw a donut shaped ring forming at the edge of the wound. The doctors office had not yet called me with the results of the biopsy, but now I was really nervous. I called and spoke to a nurse who stated, Its most likely squamous cell carcinoma but we need to wait for the biopsy.

Reduce Your Exposure To Sunlight

Keratoacanthoma: cancer or not?

Many skin changes, such as skin cancer, wrinkles, and age spots are caused by exposure to the sun. This is because the damage caused by the sun is p…

  • Apply sunscreen with sun protection factor of at least 30, even when you are going outdoors for a short time.
  • Apply a large amount of sunscreen on all exposed areas, including ears and feet.
  • Look for sunscreen that blocks both UVA and UVB light.
  • Use a water-resistant sunscreen.
  • Apply sunscreen at least 30 minutes before going out. Follow package instructions about how often to reapply. Be sure to reapply after swimming or sweating.
  • Use sunscreen in winter and on cloudy days, too.

Other measures to help you avoid too much sun exposure:

  • Ultraviolet light is most intense between 10 a.m. and 4 p.m. So try to avoid the sun during these hours.
  • Protect the skin by wearing wide-brim hats, long-sleeve shirts, long skirts, or pants. You can also buy sun-protective clothing.
  • Avoid surfaces that reflect light more, such as water, sand, concrete, and areas that are painted white.
  • The higher the altitude, the faster your skin burns.
  • Do not use sun lamps and tanning beds . Spending 15 to 20 minutes at a tanning salon is as dangerous as a day spent in the sun.

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Keratoacanthoma: Hyperplasia Benign Neoplasm Or A Type Of Squamous Cell Carcinoma

Keratoacanthomas are common self limited squamous proliferations. They have been considered a benign neoplasm with involution and complete resolution within few months. Although considered the prototypical example of cutaneous pseudomalignancy, some believe that these tumors are squamous cell carcinomas and through the years there have been sporadic reports of metastasizing keratoacanthomas. The question has been raised as to whether keratoacanthoma is an unreliable histological diagnosis or these tumors have a latent, albeit rare, malignant potential. To date, just a handful of metastasizing keratoacanthomas have been reported. Since a benign lesion is incapable of metastasis, some other explanation must be considered the most likely one being a misdiagnosis. While it is clear that in some cases, the histological and cytological features of squamous cell carcinoma and keratoacanthoma are difficult to distinguish by current techniques, these occasional limitations in diagnosis do not make keratoacanthomas a carcinoma. We believe the evidence supports that keratoacanthomas are benign squamous proliferations. The diagnosis can be made with confidence in appropriate biopsies and using well established clinicopathological criteria.

  • Previous article in issue

Squamous Cell Skin Cancer

Other namesCutaneous squamous cell carcinoma , epidermoid carcinoma, squamous cell epithelioma
SCC of the skin tends to arise from pre-malignant lesions, actinic keratoses surface is usually scaly and often ulcerates .
51,900

Squamous-cell skin cancer, also known as cutaneous squamous-cell carcinoma , is one of the main types of along with , and . It usually presents as a hard lump with a scaly top but can also form an . Onset is often over months. Squamous-cell skin cancer is more likely to than basal cell cancer. When confined to the , a precancerous or in situ form of cSCC is known as Bowen’s disease.

The greatest risk factor is high total exposure to from the Sun. Other risks include prior , chronic wounds, , , Bowen’s disease, exposure, , , , previous basal cell carcinoma, and . Risk from UV radiation is related to total exposure, rather than early exposure. are becoming another common source of ultraviolet radiation. Risk is also elevated in certain genetic skin disorders, such as and certain forms of . It begins from found within the . Diagnosis is often based on skin examination and confirmed by .

Decreasing exposure to ultraviolet radiation and the use of appear to be effective methods of preventing squamous-cell skin cancer. Treatment is typically by surgical removal. This can be by simple excision if the cancer is small otherwise is generally recommended. Other options may include and . In the cases in which distant spread has occurred or may be used.

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Natural Course Of Ka And Related Lesions After Partial Biopsy

Takai and colleagues reported the clinical courses in 66 cases of KA and related lesions after partial biopsy . They histopathologically classified these lesions into five types: solitary KA at various stages KA-like SCC KA with malignant transformation infundibular SCC and crateriform SCC arising from solar keratosis . They analyzed the clinical course in each group. The regression rate of KA was 98.1% and that of KA-like SCC/KA with malignant transformation was 33.3%. No regression was observed in either infundibular SCC or crateriform SCC arising from solar keratosis. Thus, KA is a distinct entity that should be distinguished from other types of SCC with crateriform architecture based on the high frequency of regression. The regression rate of 33.3% in KA-like SCC/KA with malignant transformation indicated that KA lesions with a SCC component retain the potential for regression. However, this also suggested that KA is biologically unstable and some KA evolves into conventional SCC with a gradual loss of the capacity for the spontaneous regression. Infundibular SCC and crateriform SCC arising from solar keratosis are fundamentally different from KA, not only according to the histopathological findings, but also based on the biological properties. Thus, the classification we present in this article is reasonable in terms of the biological behavior of each neoplasm.

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