KeratoacanthomaSee also in: External and Internal Eye,Hair and Scalp
Alerts and Notices
SynopsisA keratoacanthoma is a rapidly growing, well-differentiated neoplasm of squamous epithelium. It assumes a distinct crater-shaped appearance and usually occurs as a solitary lesion on sun-exposed skin. It is considered by many to be a low-grade squamous cell carcinoma. Men are more commonly affected than women, individuals with lighter skin phototypes are at greater risk than those with darker skin phototypes, and peak incidence is between 65 and 71 years of age.
In contrast to squamous cell carcinomas, keratoacanthomas appear and grow rapidly over the course of a few weeks to a month. If left untreated, most keratoacanthomas spontaneously involute and resolve within 6 months, leaving an atrophic scar. It is thought that the immune system plays a role in spontaneous regression of keratoacanthomas.
Most keratoacanthomas are painless. Patients occasionally complain of pruritus within the lesion. They may cause mechanical or cosmetic deformity depending on the site of involvement. Most will cause only local destruction, but there are few that behave more aggressively. These are considered invasive variants. Metastases to draining lymph nodes, while seldom, have been reported.
Risk factors include ultraviolet (UV) light exposure and immunosuppression. Patients on immunosuppressants (eg, immunosuppression after solid organ transplantation) have increased numbers of more persistent and more chronic keratoacanthomas. Skin injury may also be a predisposing factor, as there are many reports of keratoacanthomas developing in sites of previous trauma, in surgical scars, after laser resurfacing, and following radiation therapy. Foreign bodies, such as tattoo ink, have also been identified as risk factors for keratoacanthomas.
While solitary typical keratoacanthomas are the most common presentation, there are also giant (2-15 cm in diameter), subungual, mucosal, and keratoacanthoma centrifugum marginatum (prominent horizontal growth pattern) variants.
In rare cases, multiple keratoacanthomas develop as part of a syndrome.
- Ferguson-Smith syndrome is an autosomal dominant inherited disease characterized by multiple self-healing keratoacanthomas. Lesions occur within one localized area, such as on the face or trunk. Each lesion clinically resembles a solitary keratoacanthoma, and lesions scar with resolution.
- In eruptive keratoacanthomas of Grzybowski, hundreds of lesions occur in a generalized distribution and may involve mucous membranes. Pruritus is a common feature, and lesions tend to heal without scarring.
- Keratoacanthomas may occur within Muir-Torre syndrome along with sebaceous neoplasms and adenomatous colon carcinoma or other low-grade internal malignancies.
- In familial keratoacanthomas of Witten and Zak, multiple larger and smaller keratoacanthomas are found.
L85.8 – Other specified epidermal thickening
254662007 – Keratoacanthoma
Differential Diagnosis & Pitfalls
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Patient Information for Keratoacanthoma
OverviewKeratoacanthoma (KA) is a rapidly growing skin cancer usually appearing as a volcano-like bump on the sun-exposed skin of middle-aged and elderly individuals. Many scientists consider keratoacanthoma to be a less serious form of squamous cell carcinoma. Most keratoacanthoma cause only minimal skin destruction, but a few behave more aggressively and can spread to lymph nodes.
Who’s At RiskKeratoacanthoma is most commonly seen in elderly, light-skinned people with a history of sun exposure.
Risk factors for the development of keratoacanthoma include:
- Age over 50
- Fair skin, light hair, or light eyes
- Chronic exposure to sunlight or other ultraviolet light
- Exposure to certain chemicals, such as tar
- Exposure to radiation, such as X-ray treatment for internal cancers
- Long-term suppression of the immune system, such as organ transplant recipients
- Long-term presence of scars, such as from a gasoline burn
- Chronic ulcers
- Presence of particular strains of the wart virus (human papillomavirus)
- Previous skin cancer
Signs & SymptomsThe most common locations for keratoacanthoma include:
- Center of the face
- Backs of hands
- Lower legs, especially in women
In rare cases, multiple keratoacanthomas may develop as part of a larger group of symptoms (syndrome).
Most keratoacanthoma are painless, though some may be itchy. Depending on the site of involvement, keratoacanthoma may interfere with normal function of the affected area.
Self-Care GuidelinesThere are no effective self-care treatments for keratoacanthoma. Preventing sun damage is crucial to avoiding the development of keratoacanthoma:
- Avoid ultraviolet (UV) light exposure from natural sunlight or from artificial tanning devices.
- Wear broad-spectrum sunscreens (blocking both UVA and UVB) with SPF 30 or higher, reapplying frequently.
- Wear wide-brimmed hats and long-sleeved shirts.
- Stay out of the sun in the middle of the day (between 10:00 AM and 3:00 PM).
When to Seek Medical CareIf you develop a new bump (lesion) on sun-exposed skin, or if you have a spot that bleeds easily or does not seem to be healing, then you should make an appointment with your primary care physician or with a dermatologist. You should also make an appointment if an existing spot changes size, shape, color, or texture, or if it starts to itch, bleed, or become sore to the touch.
Try to remember to tell your doctor when you first noticed the lesion and what symptoms, if any, it has. Also, young adults should ask adult family members whether or not they have ever had a skin cancer and relay this information to their physician.
TreatmentsIf left untreated, most keratoacanthoma spontaneously disappear (resolve) within 6 months, leaving a depressed scar. However, they may cause significant damage to the skin and underlying layers of tissue as well as psychological distress. Additionally, rare forms of keratoacanthoma may spread (invade) aggressively below the skin level and into the lymph glands, and your doctor has no way to tell this type from the more common form. Therefore, prompt diagnosis and treatment are recommended.
If your physician suspects a keratoacanthoma, he or she will first want to establish the correct diagnosis by performing a biopsy. The procedure involves:
- Numbing the skin with an injectable anesthetic.
- Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, a stitch (suture) or 2 may be placed and will need to be removed 6-14 days later.
- Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).
- Freezing with liquid nitrogen (cryosurgery), in which very cold liquid nitrogen is sprayed on the keratoacanthoma, freezing it and destroying it in the process.
- Electrodesiccation and curettage, also known as "scrape and burn." After numbing the lesion, the doctor uses a sharp instrument (curette) to "scrape" the skin cancer cells away, followed by an electric needle to "burn" (cauterize) the tissue. The electrodesiccation helps to kill the cancer cells and also to stop any bleeding at the site.
- Removal (excision), in which the doctor uses a knife-like instrument (scalpel) to cut out the keratoacanthoma and then place stitches to bring the wound edges together.
- Mohs micrographic surgery, in which the physician takes tiny slivers of skin from the cancer site until it is completely removed. This technique is particularly useful for keratoacanthoma located on the nose, the ears, the lips, and the hands.
- Radiation treatment, where X-ray therapy is often useful for patients who might have difficulty with a surgical procedure because of other health issues.
Finally, it is important to remember that treatment of keratoacanthoma is not complete once the skin cancer has been removed. Frequent follow-up appointments with a dermatologist or with a physician trained to examine the skin are essential to ensure that the keratoacanthoma has not returned and that a new skin cancer has not developed somewhere else on your body. In addition, good sun protection habits (see the above Self-Care section) are vital to preventing further damage from UV light.
Bolognia, Jean L., ed. Dermatology, pp.1675-1676, 2326, 2328. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.741-743, 760. New York: McGraw-Hill, 2003.
KeratoacanthomaSee also in: External and Internal Eye,Hair and Scalp