Keratoacanthoma

What IS IT?

Keratoacanthomas are rapidly growing lesions in the superficial layers of the skin that often develop into a 1-2 cm dome and involute into a crater like ulcerous/necrotic lesions.  

are these Lesions Dangerous?

Keratoacanthomas are lesions of concern, as they are difficult to differentiate from squamous cell carcinomas (SCC). Most keratoacanthomas do not become SCCs and can spontaneously regress and resolve on their own.

However, some lesions contain elements that are cancerous or can change into an SCC lesion. Currently, there is no clinical measure to distinguish between benign keratoacanthomas that will resolve and those that may develop into SCC. Therefore, surgical excision with examination under the microscope is highly advised. 

What Do These lesions 

look Like?

Keratoacanthomas classically are described as dome-shaped, bud-shaped or berry-shaped, 1-2 cm papules with a central keratinous plug.

Plainly put, keratoacanthomas are protruding lesions that look like horns with a scaly/flaky central area (as one would expect with dry scaly skin) that can be black and necrotic at times. 

What Causes THis?

The risk factors for development of keratoacanthoma include: 

Skin colour

the incidence of keratoacanthomas increase in individuals with lighter skin colours. 

UV exposure 

keratoacanothomas typically grow in sun-exposed areas and there is a higher incidence in individuals who have UV light treatment for other conditions. 

Trauma and chemical exposure

sometimes, lesions develop in areas of previous iatrogenic trauma (surgery, laser therapy, cryotherapy) and accidental trauma.

Exposure to certain chemical carcinogens, such as tar, pitch, polyaromatic hydrocarbons in mineral oils, and cigarette smoking. 

Genetic syndromes

there are certain genetic syndromes that predispose individuals to developing keratoacanthomas. 

What IS THE Treatment?

There are different ways of treating keratoacanthomas. Conventionally, excision or biopsy of the lesion is recommended, as it cannot be differentiated from SCC.

Some individuals may choose to monitor the lesion, since the lesion can stay the same or spontaneously resolve on its own over several months. Other management techniques include electrodessication or curettage, intra-lesion chemotherapy, radiation therapy or topical therapy with 5-FU. These methods are often found to be more cumbersome and time-consuming with unwanted side-effects. 

 
 
 
 
 

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What Happens After I have the lesion excised?

After the lesion is excised and closed with either permanent or dissolving sutures, the specimen is sent to a pathologist who examines it under the microscope to confirm the diagnosis and to ensure that the lesion is completely excised. 

5-7days, if the lesion was on your face, or 10-14 days, if the lesion was on body parts other than the face, after your surgery, you come back to the office/clinic to review the pathology report, to check on your incision and to remove or trim your sutures. 

prevention

After your keratoacanothoma has been excised, you should continue to see your physician to monitor and ensure that the lesion will not regrow. If an individual has keratoacanthomas and/or previous skin cancers, it is important that yearly skin exams are scheduled with a physician to monitor for new lesions. Additionally, protection from further sun damage is important due to the association of UV sunlight exposure and keratoacanthomas. The use of hats and clothing that cover exposed skin, as well as sunblock is vital to prevent the development of further skin cancers. 

 
 

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