Abstract
Background: There has been a longstanding debate regarding whether keratoacanthomas (KAs) are neoplastic or reactive/inflammatory lesions. Aim: The aim of this case report is to, within the aforementioned debate, offer support in favor of the potential reactive nature of keratoacanthomas. Case Presentation: A 64-year-old male presented with an eruption of 25 keratoacanthomas within a red ink tattoo. Eruptions were partially resolved over a matter of months, and completely resolved with treatment using oral Acitretin therapy. We believe this to be the third such reported case of eruptive KAs within only the red ink portions of a tattoo. Prior cases involved 2 and 8 KAs each. Discussion: Multiple studies suggest that KAs are neoplastic in nature and very distinct from cutaneous squamous cell carcinoma. Especially interesting is the finding that KAs have increased expression of apoptotic genes; this is particularly notable because of the tendency for these lesions to spontaneously involute. Skin tumorigenesis can occur in predisposed individuals after carcinogen exposure, thus red ink possesses theoretical potential as a carcinogen. KAs could be seen in this case as in fact a reactive neoplasm.
Highlights
Keratoacanthomas (KAs) are squamous cell variant neoplastic lesions frequently encountered in clinical dermatology [1] [2]
There has been a longstanding debate regarding whether keratoacanthomas (KAs) are neoplastic or reactive/inflammatory lesions
Case Presentation: A 64-year-old male presented with an eruption of 25 keratoacanthomas within a red ink tattoo
Summary
Keratoacanthomas (KAs) are squamous cell variant neoplastic lesions frequently encountered in clinical dermatology [1] [2]. Their exact etiology is yet to be clearly understood, though most recently the literature suggests they are a folli-. KAs have been shown to react differently than most cutaneous neoplasms [3] They present distinctly as rapidly progressing erythematous papules and nodules that evolve to contain a hyperkeratotic, crateriform central crust. KAs are often treated clinically as SCC and excised before spontaneous involution occurs. This is due to the clinical and histopathologic difficulty in distinguishing the two. We report a case of eruptive KAs occurring entirely within red inked portions of a tattoo
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