Ineffectiveness of radiotherapy for the treatment of keratoacanthoma centrifugum marginatum: A case report.

Keratoacanthoma centrifugum marginatum (KCM) is a rare variant of keratoacantoma (KA). Although KCM shares histological and clinical features with KA, KCM has no tendency of spontaneous regression, and presents with progressive peripheral expansion with a bank-shaped outer wall and concurrent central healing. As such, early diagnosis and proper treatment of the patient are required. However, because of its rarity, previous reports are insufficient to evaluate which treatment should be selected. Here, we report a case of KCM that responded to radiotherapy, but relapsed 6 months later.

Self-Resolving Eruptive Keratoacanthomas After Full-Field Erbium Laser Resurfacing.

Keratoacanthoma (KA) is a subtype of squamous cell carcinoma whose development has been linked to excessive sun exposure, immunosuppression, and trauma. Given the rapidly expanding therapeutic armamentarium for anti-aging modalities in dermatology, reports of KA secondary to invasive cosmetic procedures are on the rise. We present a case of eruptive KAs after full- eld ablative Erbium:YAG 2940 nm laser resurfacing of the face that resolved with minimal intervention. This case demonstrates the potential for a rare yet signi cant laser complication that may warrant discussion during the consenting process. J Drugs Dermatol. 2016;15(11):1453-1455..

Superficial radiotherapy for multiple keratoacanthomas.

We report the case of a 76-year-old Caucasian woman who attended our clinic with multiple keratoacanthomas. Radiotherapy was considered a viable and effective option in such an old patient, who could not be a good surgical candidate for number and distribution of the lesions, and for the age. After a 12-month follow-up, we observed the complete and global disappearance of the lesions; the patient was therefore very satisfied especially in view of the clinical outcome. According to our point of view, radiotherapy allows the physician to obtain a good oncological radicality and excellent cosmetic results too.

Severe exacerbation of multiple self-healing squamous epithelioma (Ferguson-Smith disease) with radiotherapy, which was successfully treated with acitretin.

We describe the challenging case of a patient presenting with extensive, eruptive mid-facial squamous cell carcinomas (SCCs) and keratoacanthomas (KAs) consequent to radiotherapy. Our patient had a personal and family history of multiple KAs and SCCs. Multiple self-healing squamous epithelioma, otherwise known as Ferguson-Smith disease, was diagnosed. This case presented a therapeutic challenge to preserve tissue and avoid severe facial disfigurement. We found oral acitretin to be the treatment of choice.

[Giant keratoacanthoma in an immunocompetent patient with detection of HPV 11]. / Riesenkeratoakanthom bei einem immunkompetenten Patienten mit Nachweis von HPV 11.

A 47-year-old immunocompetent man presented with a nodule on the right side of the upper lip that appeared suddenly and grew rapidly. Histological examination was consistent with the diagnosis of keratoacanthoma which is often associated with immunosuppression. Low-risk HPV type 11 was detected in the PCR analysis. While formerly one often waited for spontaneous regression of keratoacanthomas, today one routinely treats them as a well-differentiated squamous cell carcinoma. Complete surgical excision was not possible in our patient because of the size of the tumor. Radiation with a cumulative dose of 30 Gray (15 sessions of 2 Gray) led to complete remission. In addition to ultraviolet exposure, trauma, genetic factors and chemical carcinogens, HPV should be considered as a possible cofactor in the etiology of keratoacanthoma.

Keratoacanthoma centrifugum marginatum: a rare atypical variant of keratoacanthoma.

Keratoacanthoma centrifugum marginatum (KCM) is an extremely rare variant of keratoacanthoma (KA), with about 30 cases reported since it was first described in 1962. Clinically, KA is an exoendophytic lesion of 10-25 mm with a horn-filled crater that resolves spontaneously within 6 months. In contrast, KCM is characterized by a larger diameter continuous centrifugal spread, concurrent central atrophy and lack of spontaneous remission. Histologically, KCM is similar to KA, with a central keratin-filled crater, overhanging lips of epithelium, a sharp outline between the tumour nests and stroma, and lack of anaplasia and stroma desmoplasia. We describe a 63-year-old agricultural worker with a 9-month history of a multinodular tumour, 70-75 mm in size, on his right hand. The clinical diagnosis of KCM was confirmed by histological examination. Local radiotherapy proved effective, with no recurrence during a 4-year follow-up.

Keratoacanthoma in vitiligo lesion after UVB narrowband phototherapy.

The treatment of vitiligo is still a challenge. Among various therapeutic modalities, phototherapy with UVB narrowband (UVB-NB) is presently considered a treatment of choice for this skin disease. The exact skin cancer risk deriving from UVB-NB is a serious concern to be determined. We report a case of keratoacanthoma developed in the vitiligo area during a prolonged course of UVB-NB therapy.

[High-dose multimodal radiotherapy of confluent destructively growing aggregated keratoacanthoma. 2 case reports]. / Hochdosierte multimodale Radiotherapie konfluierend-destruierend wachsender, aggregierter Keratoakanthome, Zwei Falldarstellungen.

BACKGROUND: Keratoacanthoma is a fairly common, benign, usually self-resolving skin lesion that arises from the hair follicle. This nodular lesion shows a predilection for areas exposed to light, mainly for the face. We report on the intensive radiation therapy of 2 cases of a rare subset of keratoacanthoma which showed a locally aggressive, seriously destructive growth. PATIENTS AND METHODS: Two female patients with previously treated, confluent-destructive growing keratoacanthoma were treated by multimodal, high-dose radiotherapy. Patient 1 showed a rapid progress of midfacial tumor with destructive infiltration of the left cheek, nasal cartilage, the cribriform plate of ethmoid and congestion of the conjunctiva close to the lacrimal caruncle. This could be shown in clinical and histopathological investigations and CT-scans. The coexistence of cutaneous and conjunctival lesions in locally rapidly enlarging keratoacanthoma of the face is unusual and unreported to our knowledge. One case of simultaneous conjunctival and multiple, eruptive keratoacanthoma of the body has been reported. Patient 2 had received soft X-ray pretreatment because of a large, relapsing keratoacanthoma of the left cheek. RESULTS: Patient 1 underwent a parallel, intensive treatment of the conjunctiva with 90Sr-contact therapy, percutaneous high-dose 60Co-gamma- and megavoltage electron treatment (10 and 18 MeV) of the midfacial lesions. Conjunctiva and caruncle showed a complete remission of keratoacanthoma. In the other facial areas no long-term regression could be reached, despite giving a fully cancericidal, total dose of more than 100 Gy in some regions. Patient 2: Further high dose radiotherapy using megavoltage electron treatment with a total dose of 50 Gy showed a complete remission of the lesion for 5 months. Another relapse of this keratoacanthoma could be operated successfully. There was no more relapse established in follow-up checks. CONCLUSIONS: The 2 case reports show that in treatment of locally destructive growing subsets of keratoacanthoma a sufficient therapy should be initiated in time. Keratoacanthoma and subsets of this lesion that do not respond well to initial treatment, recur early or show seriously aggressive growth should be treated early by combined therapy that takes previous experiences into consideration.

Radiation therapy of giant aggressive keratoacanthomas.

BACKGROUND AND DESIGN: Giant aggressive keratoacanthoma is a rare destructive subset of keratoacanthoma that frequently involves the facial region, grows rapidly to a large size, and often recurs after surgical management. The effectiveness of ionizing radiation therapy was examined in a retrospective study involving 16 patients; 14 of the tumors had recurred after surgical therapy. RESULTS: All tumors resolved with satisfactory cosmetic results and without recurrence following a fractionated course of superficial radiation therapy. CONCLUSIONS: Radiation therapy is an effective therapeutic modality for giant aggressive keratoacanthomas.

Treatment of aggressive keratoacanthomas by radiotherapy.

Keratoacanthomas infrequently are treated by radiotherapy. However, keratoacanthomas that are recurrent after surgical excision or whose resection would result in cosmetic deformity may benefit from radiotherapy. Between January 1970 and June 1988, 29 such keratoacanthomas in 18 patients were irradiated. Doses ranged from 3500 cGy in 15 fractions to 5600 cGy in 28 fractions. Measured end points of therapy were (1) initial response, (2) freedom from recurrence, and (3) quality of the subsequent cosmetic appearance (scored as good, fair, or poor). No lesion progressed and all eventually regressed completely. Cosmetic results generally were considered good by both the patient and the referring dermatologist; none of the results was considered poor. Our results demonstrate that radiation is an effective means of treating keratoacanthomas.

Radiation therapy of keratoacanthomas: results in 55 patients.

The radiation therapy of keratoacanthomas in fifty-five patients treated between 1976 and 1986 using orthovoltage X rays (contact and soft X ray therapy) is reported. The total dose delivered was 40 Gy by means of twice weekly fractions of 4 Gy each in 52 cases, and 60 Gy by twice weekly fractions of 5 Gy each in 3 cases with notable cellular atypia. In all cases we obtained complete regression of the lesions irradiated within 1 month after the termination of radiotherapy. So far we have not had any recurrences. The cosmetic result was always satisfactory. We should like to point out the association between keratoacanthomas and a second malignancy in two cases. The role of radiotherapy in the treatment of keratoacanthomas is discussed and re-confirmed, in relation to the literature data.

[Differential x-ray therapy of keratoacanthoma. A clinical case]. / Röntgendifferentialtherapie des Keratoakanthoms--Ein kasuistischer Beitrag.

Differential radiotherapy is a way of making a diagnosis and treatment for keratoacanthoma at the same time. After having taken a punch biopsy in order to exclude basal cell carcinoma, we give an X-ray dose of 2500 r. This dose is sufficient to induce the healing of keratoacanthoma. If there is no tendency of healing, the tumor must be a squamous cell carcinoma. In this case, we apply the full tumor dose of totally 5000 r.

Radiation therapy of keratoacanthoma.

We report the radiation therapy of keratoacanthoma in 13 patients using orthovoltage X rays and electrons. All patients had an excellent cosmetic result, and time to regression was dose dependent up to a dose corresponding to TDF 50; increasing dose beyond this level did not accelerate time to regression past 2.4 months. We also note a heretofore undocumented association between keratoacanthoma and second malignancy.

Keratoacanthoma recurrent after surgical excision.

A 62-year-old man developed a recurrent keratoacanthoma within two and a half weeks after grossly and microscopically complete removal of the primary tumor. X-irradiation of the recurrent lesion caused partial regression, and then intralesional injections of a suspension of triamicinolone caused final resolution of it. Although dermatologists generally practice partial destruction and surgeons almost always do total excision, neither method invariably cures this benign tumor, and repeated treatment may be necessary.