Abstract
Keratoacanthomas (KAs) are fast-growing tumors and can be difficult to distinguish from squamous cell carcinomas (SCCs). Most KAs are sporadic, but KAs may also arise following traumatic procedures. We report the case of a 94-year-old male who developed multiple KAs following surgical excision of an SCC on the right lower extremity. The patient declined additional procedures including biopsy, surgery, or intralesional therapy. He was started on 5% topical FU using a 2 week on, 2 week off regimen for 16 weeks with resolution of disease. No recurrence was noted at 13 months. Topical 5-FU is a conservative, non-invasive treatment for post-traumatic KAs that is particularly suitable in the elderly, in whom the risks and morbidity from surgical or other non-invasive approaches are worth considering.
Highlights
Keratoacanthoma (KA) is a rapidly growing, low-grade variant of cutaneous squamous cell carcinoma that often arises as a solitary lesion on sun-exposed skin in adults over age 40
The most commonly used 5fluorouracil formulations were the 5% ointment (35%), 20% ointment (33%) and 5% cream (30%)
Further systematic study into this phenomenon is needed to better outline treatment parameters and resolve the question of whether, under certain circumstances, eruptive KAs may regress spontaneously
Summary
Keratoacanthoma (KA) is a rapidly growing, low-grade variant of cutaneous squamous cell carcinoma that often arises as a solitary lesion on sun-exposed skin in adults over age 40. Following a rapid growth phase, KAs may spontaneously regress, but predicting which tumors will do so is challenging. For this reason, KAs are often treated with surgery, non-surgical modalities have been employed, including intralesional 5-FU, intralesional methotrexate, or oral retinoids. KAs are often treated with surgery, non-surgical modalities have been employed, including intralesional 5-FU, intralesional methotrexate, or oral retinoids Response rates with these non-surgical therapies vary, ranging from 83 to 100%.1. We present the case of a very elderly gentleman with multiple post-operative eruptive KAs treated successfully with topical 5-fluorouracil and review the literature on KAs treated with topical 5-fluorouracil
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