1
|
Monroy D, Alvarez OP, Venkateswaran N, Matthews JL, Tan C, Garcia A, Diaz PFM, Quan A, Winnick M, Galor A, Elgart GW, Karp CL, Dubovy SR. Conjunctival keratoacanthoma: a clinical and histopathological case series. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00243-6. [PMID: 39147368 DOI: 10.1016/j.jcjo.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/15/2024] [Accepted: 07/29/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To present a series of conjunctival keratoacanthomas and provide clinical, histopathological, immunohistochemical, and imaging results that characterize this rare entity. METHODS A retrospective chart review of records from 2005 to 2023 from the Florida Lions Ocular Pathology Laboratory was conducted. Nine patients with histologically proven conjunctival keratoacanthoma were identified. Data extracted includes demographics, clinical history, diagnostic testing, histopathological and immunohistochemical testing, treatment modalities, and recurrences. RESULTS Patients' mean age was 55.2 ± 21.1 years (range: 22-83). 77.8% (7/9) of patients were male. 55.6% (5/9) were Hispanic. 55.6% of lesions (5/9) were in right eyes. 55.6% of lesions (5/9) were on the temporal, bulbar conjunctiva. The lesions were rapidly growing, with mean onset time of 4.71 ± 3.30 weeks (range: 2-12). High-resolution anterior segment optical coherence tomography of three lesions revealed hyper-reflective, thickened epithelium with abrupt transition between normal and abnormal epithelium. Underlying disorganized subepithelial tissue was noted. However, the overlying abnormal epithelium caused considerable shadowing, which obscured subepithelial structures. Prominent, keratin-filled, cup-shaped lesions with faulty maturational sequencing that extend full thickness, variably pale cytoplasm, and foci of dyskeratosis and hyperkeratosis were present on all lesions' histopathology. All lesions were surgically excised, but two demonstrated partial spontaneous resolution before surgery. Two patients were lost to follow-up; the remaining seven had no signs of recurrence at a of mean of 36.9 ± 45.4 months (range: 3 to 141 months) of follow-up. CONCLUSIONS Conjunctival keratoacanthomas are rare lesions of the ocular surface with distinct clinical, histopathologic, and diagnostic features.
Collapse
Affiliation(s)
- David Monroy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Osmel P Alvarez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States; Duke University School of Medicine, Durham, North Carolina, United States
| | - Nandini Venkateswaran
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Jared L Matthews
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Charissa Tan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Armando Garcia
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | | | - Ann Quan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Marc Winnick
- Delray Eye Associates, Delray Beach, Florida, United States
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, United States
| | - George W Elgart
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States.
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| |
Collapse
|
2
|
Baeza-Hernández G, Cañueto J. Intralesional Treatments for Invasive Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2023; 16:158. [PMID: 38201585 PMCID: PMC10778043 DOI: 10.3390/cancers16010158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most frequent cancer in humans and has the potential to progress locally, metastasize, and cause death in a subset of patients. cSCC is especially common in the elderly, and it will probably represent a major health concern in the near future. Surgery is the standard treatment for cSCC, but intralesional therapies can sometimes be considered for certain patients and under certain circumstances. The choice of intralesional treatment depends on the patient's characteristics and the clinician's previous experience and expertise. Here we are reviewing intralesional treatments for cSCC and keratoacanthoma (KA). We have started with some classic drugs, such as methotrexate and 5-fluorouracil, bleomycin, interferon, and cryosurgery, but also comment on electrochemotherapy. Finally, we have focused on novel therapies, some of which are under development, and future perspectives, including intralesional immunotherapy and oncolytic viruses.
Collapse
Affiliation(s)
- Gloria Baeza-Hernández
- Department of Dermatology, Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain;
| | - Javier Cañueto
- Department of Dermatology, Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain;
- Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Centro de Investigación del Cáncer (CIC)-CSIC, Laboratory 20, 37008 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, Hospital Virgen de la Vega, 10ª Planta, 37007 Salamanca, Spain
| |
Collapse
|
3
|
Neuner RA, Lee J, Rieger KE, Park C, Colevas AD, Chang ALS. Immunotherapy for keratinocyte cancers. Part I: Immune-related epidemiology, risk factors, pathogenesis, and immunotherapy management of keratinocyte cancers. J Am Acad Dermatol 2023; 88:1225-1240. [PMID: 37268390 DOI: 10.1016/j.jaad.2022.06.1206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 06/04/2023]
Abstract
The important role of the immune system in the surveillance and control of keratinocyte cancers (KCs), namely squamous and basal cell carcinomas, is increasingly appreciated, as new immunotherapies have recently become available. As the field of immunotherapy is rapidly evolving, this review synthesizes key concepts and highlights important cellular components within the immune system responsible for attacking KCs. We review the most current data on the epidemiology, risk factors, and immunotherapy management for KCs. Patients will seek advice from dermatologists to help explain why immunotherapies work for KCs and whether they might be appropriate for different clinical scenarios. Collaboration with medical colleagues across different disciplines to evaluate KCs for response to immunotherapy and early recognition of immune-related adverse events will help to optimize patient outcomes.
Collapse
Affiliation(s)
- Romy A Neuner
- Department of Internal Medicine, Spital Uster, Zurich, Switzerland
| | - Jinwoo Lee
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Kerri E Rieger
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Caroline Park
- Department of Geriatric Medicine, Geriatric Research Education and Clinical Center (GRECC), Veterans Administration, Palo Alto Healthcare System, Stanford University School of Medicine, Palo Alto, California
| | - Alexander D Colevas
- Department of Medicine-Oncology, Stanford University School of Medicine, Stanford, California
| | - Anne Lynn S Chang
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California.
| |
Collapse
|
4
|
Melero I, Castanon E, Alvarez M, Champiat S, Marabelle A. Intratumoural administration and tumour tissue targeting of cancer immunotherapies. Nat Rev Clin Oncol 2021; 18:558-576. [PMID: 34006998 PMCID: PMC8130796 DOI: 10.1038/s41571-021-00507-y] [Citation(s) in RCA: 218] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Immune-checkpoint inhibitors and chimeric antigen receptor (CAR) T cells are revolutionizing oncology and haematology practice. With these and other immunotherapies, however, systemic biodistribution raises safety issues, potentially requiring the use of suboptimal doses or even precluding their clinical development. Delivering or attracting immune cells or immunomodulatory factors directly to the tumour and/or draining lymph nodes might overcome these problems. Hence, intratumoural delivery and tumour tissue-targeted compounds are attractive options to increase the in situ bioavailability and, thus, the efficacy of immunotherapies. In mouse models, intratumoural administration of immunostimulatory monoclonal antibodies, pattern recognition receptor agonists, genetically engineered viruses, bacteria, cytokines or immune cells can exert powerful effects not only against the injected tumours but also often against uninjected lesions (abscopal or anenestic effects). Alternatively, or additionally, biotechnology strategies are being used to achieve higher functional concentrations of immune mediators in tumour tissues, either by targeting locally overexpressed moieties or engineering 'unmaskable' agents to be activated by elements enriched within tumour tissues. Clinical trials evaluating these strategies are ongoing, but their development faces issues relating to the administration methodology, pharmacokinetic parameters, pharmacodynamic end points, and immunobiological and clinical response assessments. Herein, we discuss these approaches in the context of their historical development and describe the current landscape of intratumoural or tumour tissue-targeted immunotherapies.
Collapse
Affiliation(s)
- Ignacio Melero
- Department of Immunology, Clínica Universidad de Navarra, Pamplona, Spain.
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain.
- Program for Immunology and Immunotherapy, Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.
| | - Eduardo Castanon
- Department of Immunology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maite Alvarez
- Program for Immunology and Immunotherapy, Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Stephane Champiat
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Université Paris Saclay, Gustave Roussy, Villejuif, France
- INSERM U1015, Gustave Roussy, Villejuif, France
- Biotherapies for In Situ Antitumor Immunization (BIOTHERIS), Centre d'Investigation Clinique INSERM CICBT1428, Villejuif, France
| | - Aurelien Marabelle
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Université Paris Saclay, Gustave Roussy, Villejuif, France.
- INSERM U1015, Gustave Roussy, Villejuif, France.
- Biotherapies for In Situ Antitumor Immunization (BIOTHERIS), Centre d'Investigation Clinique INSERM CICBT1428, Villejuif, France.
| |
Collapse
|
5
|
Vidovic D, Simms GA, Pasternak S, Walsh M, Peltekian K, Stein J, Helyer LK, Giacomantonio CA. Case Report: Combined Intra-Lesional IL-2 and Topical Imiquimod Safely and Effectively Clears Multi-Focal, High Grade Cutaneous Squamous Cell Cancer in a Combined Liver and Kidney Transplant Patient. Front Immunol 2021; 12:678028. [PMID: 34122442 PMCID: PMC8190543 DOI: 10.3389/fimmu.2021.678028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/07/2021] [Indexed: 01/04/2023] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common non-melanoma skin cancer worldwide, with ever increasing incidence and mortality. While most patients can be treated successfully with surgical excision, cryotherapy, or radiation therapy, there exist a subset of patients with aggressive cSCC who lack adequate therapies. Among these patients are solid organ transplant recipients who due to their immunosuppression, develop cSCC at a dramatically increased rate compared to the normal population. The enhanced ability of the tumor to effectively undergo immune escape in these patients leads to more aggressive tumors with a propensity to recur and metastasize. Herein, we present a case of aggressive, multi-focal cSCC in a double organ transplant recipient to frame our discussion and current understanding of the immunobiology of cSCC. We consider factors that contribute to the significantly increased incidence of cSCC in the context of immunosuppression in this patient population. Finally, we briefly review current literature describing experience with localized therapies for cSCC and present a strong argument and rationale for consideration of an IL-2 based intra-lesional treatment strategy for cSCC, particularly in this immunosuppressed patient population.
Collapse
Affiliation(s)
- Dejan Vidovic
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, NS, Canada
| | - Gordon A. Simms
- Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, NS, Canada
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, NS, Canada
| | - Mark Walsh
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, NS, Canada
| | - Kevork Peltekian
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, NS, Canada
| | - John Stein
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, NS, Canada
| | - Lucy K. Helyer
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, NS, Canada
| | - Carman A. Giacomantonio
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, NS, Canada
| |
Collapse
|
6
|
Panagiotopoulos A, Kyriazis N, Polychronaki E, Leotsakos GD, Vassis P, Rigopoulos D. The Effectiveness of Cryosurgery Combined with Curettage and Electrodessication in the Treatment of Keratoacanthoma: A Retrospective Analysis of 90 Cases. Indian J Dermatol 2020; 65:406-408. [PMID: 33165435 PMCID: PMC7640789 DOI: 10.4103/ijd.ijd_202_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There are several treatment options for keratoacanthoma (KA). However, there are limited data available on the use of cryosurgery. Objective: To evaluate the effectiveness and safety of a combination treatment for KA and to evaluate the cosmetic outcome. Materials and Methods: The combination treatment incorporates the use of curettage, electrodessication, and cryotherapy. A retrospective study was conducted on 90 patients with KA who had been treated with this method between 2000 and 2014. The follow-up period lasted 2 years and photographs were available for every visit of the patients to the department. Results: The success rate was found to be 97.8%. No serious adverse events were observed. No infections were reported. The cosmetic outcome was evaluated as excellent for all patients. Discussion: The combination method appears to combine the advantages of both destructive treatment and surgical excision. It appears to be a safe and effective treatment method. However, there are certain limitations to this study. Conclusions: More studies are needed to evaluate the effectiveness and safety of this method.
Collapse
Affiliation(s)
- Antonios Panagiotopoulos
- National and Kapodistrian University of Athens, Andreas Syggros Hospital of Cutaneous and Venereal Diseases, Cryosurgery Unit, Athens, Greece
| | - Nikolaos Kyriazis
- National and Kapodistrian University of Athens, Andreas Syggros Hospital of Cutaneous and Venereal Diseases, Cryosurgery Unit, Athens, Greece
| | - Eleni Polychronaki
- National and Kapodistrian University of Athens, Andreas Syggros Hospital of Cutaneous and Venereal Diseases, Cryosurgery Unit, Athens, Greece
| | - George D Leotsakos
- National and Kapodistrian University of Athens, Andreas Syggros Hospital of Cutaneous and Venereal Diseases, Cryosurgery Unit, Athens, Greece
| | - Polytimos Vassis
- National and Kapodistrian University of Athens, Andreas Syggros Hospital of Cutaneous and Venereal Diseases, Cryosurgery Unit, Athens, Greece
| | - Dimitrios Rigopoulos
- National and Kapodistrian University of Athens, Andreas Syggros Hospital of Cutaneous and Venereal Diseases, Cryosurgery Unit, Athens, Greece
| |
Collapse
|
7
|
Kiss N, Avci P, Bánvölgyi A, Lőrincz K, Szakonyi J, Gyöngyösi N, Fésűs L, Lee G, Wikonkál N. Intralesional therapy for the treatment of keratoacanthoma. Dermatol Ther 2019; 32:e12872. [DOI: 10.1111/dth.12872] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/24/2019] [Accepted: 03/11/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Norbert Kiss
- Department of Dermatology, Venereology and DermatooncologySemmelweis University Budapest Hungary
| | - Pinar Avci
- Department of Dermatology, Venereology and DermatooncologySemmelweis University Budapest Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereology and DermatooncologySemmelweis University Budapest Hungary
| | - Kende Lőrincz
- Department of Dermatology, Venereology and DermatooncologySemmelweis University Budapest Hungary
| | - József Szakonyi
- Department of Dermatology, Venereology and DermatooncologySemmelweis University Budapest Hungary
| | - Nóra Gyöngyösi
- Department of Dermatology, Venereology and DermatooncologySemmelweis University Budapest Hungary
| | - Luca Fésűs
- Department of Dermatology, Venereology and DermatooncologySemmelweis University Budapest Hungary
| | - Goeun Lee
- Department of Dermatology, Venereology and DermatooncologySemmelweis University Budapest Hungary
| | - Norbert Wikonkál
- Department of Dermatology, Venereology and DermatooncologySemmelweis University Budapest Hungary
| |
Collapse
|
8
|
Russo I, Sernicola A, Alaibac M. Recent advances in localized immunotherapy of skin cancers. Immunotherapy 2019; 11:443-456. [PMID: 30786845 DOI: 10.2217/imt-2018-0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Skin cancer is the most frequent malignancy in humans. The immune system has long been known to have an important role in defeating cancer. Immunotherapy, which includes various strategies to enhance tumor immunity, currently represents an exciting option for the treatment of skin cancers. Local immunotherapy is a promising therapeutic approach and may improve response rates without inducing systemic toxicity. Here, we review the main localized immunotherapies for the management of skin cancer with a special focus on advanced melanoma, nonmelanoma skin cancer and primary cutaneous lymphoma.
Collapse
Affiliation(s)
- Irene Russo
- Unit of Dermatology, University of Padua, Via Gallucci 4, Padova 35128, Italy
| | - Alvise Sernicola
- Unit of Dermatology, University of Padua, Via Gallucci 4, Padova 35128, Italy
| | - Mauro Alaibac
- Unit of Dermatology, University of Padua, Via Gallucci 4, Padova 35128, Italy
| |
Collapse
|
9
|
Abstract
The giant keratoacanthoma (KA) is a rare variant of KA with a maximum size exceeding 2-3 cm. Like other forms of KA, it has a tendency to spontaneously regress but can cause significant anatomic damage. A 69-year-old male presented to our hospital with a giant KA of the nose that showed complete pathological regression by the time of surgery. Pathology showed dermal scar with keratin granulomas extending through the nasal wall to the respiratory mucosa. A total of 57 similar cases from the English literature were reviewed for comparison. Few provide similar details of histological regression. Literature cases occurred predominately in males (74.1%) with a mean age of 59 years. Head tumors were most common (70.7%) and most were treated by surgery (34.5%) or a combination of surgery and radiotherapy (24.1%). Other treatment modalities reported include methotrexate, 5-fluorouracil, and interferon.
Collapse
|
10
|
Hanlon A, Kim J, Leffell DJ. Intralesional interferon alfa-2b for refractory, recurrent squamous cell carcinoma of the face. J Am Acad Dermatol 2014; 69:1070-2. [PMID: 24238178 DOI: 10.1016/j.jaad.2013.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/21/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Allison Hanlon
- Department of Dermatology, Section of Cutaneous Oncology and Dermatologic Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | | | | |
Collapse
|
11
|
Chitwood K, Etzkorn J, Cohen G. Topical and Intralesional Treatment of Nonmelanoma Skin Cancer: Efficacy and Cost Comparisons. Dermatol Surg 2013; 39:1306-16. [DOI: 10.1111/dsu.12300] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Bonerandi JJ, Beauvillain C, Caquant L, Chassagne JF, Chaussade V, Clavère P, Desouches C, Garnier F, Grolleau JL, Grossin M, Jourdain A, Lemonnier JY, Maillard H, Ortonne N, Rio E, Simon E, Sei JF, Grob JJ, Martin L. Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma and precursor lesions. J Eur Acad Dermatol Venereol 2012; 25 Suppl 5:1-51. [PMID: 22070399 DOI: 10.1111/j.1468-3083.2011.04296.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J J Bonerandi
- Department of Dermatology, La Timone University Hospital, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kirby JS, Miller CJ. Intralesional chemotherapy for nonmelanoma skin cancer: a practical review. J Am Acad Dermatol 2010; 63:689-702. [PMID: 20605654 DOI: 10.1016/j.jaad.2009.09.048] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 09/22/2009] [Accepted: 09/23/2009] [Indexed: 11/27/2022]
Abstract
Intralesional chemotherapy for nonmelanoma skin cancer has existed for more than 5 decades. However, it is used so infrequently that recent consensus guidelines for the treatment of basal cell and squamous cell carcinoma do not include intralesional chemotherapy. Barriers to the use of intralesional chemotherapy include the off-label use of these agents, absence of therapeutic guidelines, a relatively small number of patients treated, and a lack of large, well-designed trials with long-term follow-up. Surgical intervention remains the gold standard for the treatment of nonmelanoma skin cancer; however, intralesional chemotherapy remains an option for well-selected patients who cannot or will not undergo surgery. The objectives of this article are to determine response rates and suggest reasonable treatment guidelines for the treatment of squamous cell carcinoma, keratoacanthoma, and basal cell carcinoma with the most widely available intralesional agents (methotrexate, 5-fluorouracil, bleomycin, and interferon).
Collapse
Affiliation(s)
- Joslyn S Kirby
- Department of Dermatology, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA.
| | | |
Collapse
|
14
|
Good LM, Miller MD, High WA. Intralesional agents in the management of cutaneous malignancy: a review. J Am Acad Dermatol 2010; 64:413-22. [PMID: 20334952 DOI: 10.1016/j.jaad.2009.12.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 12/02/2009] [Accepted: 12/06/2009] [Indexed: 12/17/2022]
Abstract
Intralesional agents have a role in the management of cutaneous malignancies. In this article, the efficacy, side effects, strengths, limitations, costs, and practical considerations regarding the use of intralesional agents to treat basal cell carcinoma, squamous cell carcinoma, selected cutaneous lymphomas, and even metastatic melanoma are reviewed. Intralesional administration of 5-fluorouracil, interferon, interleukin-2, bleomycin with electrochemotherapy, and aminolevulinic acid with photodynamic therapy are discussed as treatment modalities in basal cell carcinoma. Interferon (∼1.5 M IU, 3 times weekly × 3 weeks) is perhaps the most widely used regimen for basal cell carcinoma. With regard to squamous cell carcinoma, treatment with 5-fluorouracil, methotrexate, interferon, and bleomycin are reviewed. Methotrexate (∼0.3-2.0 mL of 12.5 or 25 mg/mL, two injections ∼2 weeks apart) was perhaps the most widely used agent. Interferon (3 M IU × 3 times weekly for ∼8.5 weeks) and rituximab (10-30 mg per lesion, 3 times weekly for 1 week, possibly repeated 4 weeks later) are sometimes used in the management of primary cutaneous B-cell lymphomas, whereas in primary cutaneous CD30(+) lymphoma intralesional methotrexate (0.4-0.5 mL of 50 mg/mL weekly for 2 weeks) has been used. Finally, the roles of BCG vaccine, cidofovir, rose bengal, and bleomycin with electrochemotherapy for the palliation of metastatic melanoma are reviewed. Intralesional management appears most useful when surgical intervention is not a viable option, for cases in which the cosmetic outcome may be superior, or for situations in which the side effects from systemic chemotherapeutic agents are to be minimized.
Collapse
Affiliation(s)
- Laurie M Good
- Department of Dermatology, University of Colorado Health Sciences Center, Denver, CO, USA
| | | | | |
Collapse
|
15
|
Carcinome épidermoïde cutané (carcinome spinocellulaire) : Recommandations de pratique clinique pour la prise en charge diagnostique et thérapeutique Argumentaire - Mai 2009. Ann Dermatol Venereol 2009. [DOI: 10.1016/s0151-9638(09)75172-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
16
|
Burdick LM, Somani N, Somani AK. Type I IFNs and their role in the development of autoimmune diseases. Expert Opin Drug Saf 2009; 8:459-72. [PMID: 19548860 DOI: 10.1517/14740330903066726] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Since their initial use in the 1980s, IFNs have become an essential component of the therapy for many diseases such as hepatitis and multiple sclerosis. Although they have been extremely useful in conditions that pose therapeutic challenges, complications associated with their use have been widely reported including emerging reports of several autoimmune diseases. Many of these reports have shed light on the pathogenesis of autoimmune disorders and helped to highlight not only the critical role of type I IFNs in defense against viral infections but also the pivotal role they occupy in the interface between innate and adaptive immunity. Many patients with autoimmune disease have increased responsiveness to type I IFNs (alpha/beta), and therapy with these cytokines has induced or unmasked autoimmune disease in many additional patients. OBJECTIVE The objective of this paper is to discuss the role of type I IFNs in autoimmunity. METHODS The literature regarding type I IFNs and autoimmunity was reviewed using the Medline database from 1950 to 2009. Search terms included 'interferon alpha' and 'autoimmune disease' and 'interferon beta' and 'autoimmune disease'. Case reports, case series, reviews and prospective studies were included in the analysis. RESULTS/CONCLUSIONS In the literature a variety of autoimmune disorders have reportedly been induced by the use of type I IFNs, being used, although these are primarily in the form of case reports and case series. Nevertheless, there is a growing body of molecular evidence to support the clinical association. The role of IFNs in the induction of autoimmunity is complex with interplay of many genetic and environmental factors that influence the balance between normal and aberrant immune responsiveness, ultimately leading to the observed clinical manifestations.
Collapse
Affiliation(s)
- Laura M Burdick
- Dermatology & Plastic Surgery Institute, Cleveland Clinic Health System, Department of Dermatology, 9500 Euclid Avenue, Desk A61, Cleveland, Ohio 44195, USA
| | | | | |
Collapse
|
17
|
International Literature Reviews: Progress in dermatological treatments in France in 1993. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639409084564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
18
|
Cribier B. Vous avez dit kératoacanthome ? Dites plutôt « carcinome spinocellulaire à type de kératoacanthome ». Ann Dermatol Venereol 2008; 135:541-6. [DOI: 10.1016/j.annder.2008.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Soft Tissue Tumors of the Hand. 2. Malignant. Dermatol Surg 2007. [DOI: 10.1097/00042728-200707000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Abstract
Soft tissue tumors of the hand arise from skin, subcutaneous tissue, tendons, nerve, and blood vessels. Many of these lesions occur on other parts of the body; however, the hand remains a unique site because these tumors have symptoms, appearances, treatments, and prognoses that may be quite different than when on other parts of the body. Their characteristics and the severity of symptoms vary markedly depending on the exact location, size, and type of tumor-and many of these tumors can have multiple forms of presentation. Two articles are intended to provide an overview of benign (previous article) and malignant tumors (this article) of the hand. The rarer and more deleterious tumors are discussed in detail while the common tumors and epidermal lesions with which practitioners are familiar are briefly overviewed. At the completion of these review articles, participants should be able to identify and diagnose various benign and malignant hand tumors as well as understand the accepted current treatment of these growths.
Collapse
Affiliation(s)
- Joseph F Sobanko
- Department of Dermatology, Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA.
| | | | | | | |
Collapse
|
21
|
Feldman RJ, Maize JC. Multiple keratoacanthomas in a young woman: report of a case emphasizing medical management and a review of the spectrum of multiple keratoacanthomas. Int J Dermatol 2007; 46:77-9. [PMID: 17214727 DOI: 10.1111/j.1365-4632.2006.02948.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 27-year-old white woman was referred for consultation with regard to the presence of extensive multiple keratotic lesions. She began to develop these lesions at the age of 9 years, with healing of the lesions resulting in scar formation. A biopsy was performed at the age of 16 years, but the patient was unsure of the results. Since then, she had not had any treatment or biopsies, and stated that she had not suffered from any health problems during the intervening period. She was most concerned about the tumors on her heels and soles, which caused difficulty with ambulation. The family history was negative for skin diseases, including melanoma, nonmelanoma skin cancer, psoriasis, and eczema, and positive for Type II diabetes mellitus. A relative reported that the patient's grandfather had similar lesions, but the patient's parents and siblings were healthy. She was married and had one child, a 9-year-old daughter. Her child had no skin lesions. The patient's only medication was Ortho-Tricyclene birth control pills. She had no known drug allergies. Physical examination revealed the presence of multiple lesions on her body (Fig. 1). Her left superior helix contained a well-demarcated, dome-shaped nodule with a rolled, mildly erythematous border with a central hyperkeratotic plug. A similar lesion was present in the scaphoid fossa of the left ear and smaller lesions were scattered on her face. Numerous lesions were present on the arms and legs bilaterally, with the majority of lesions being located on the anterior lower legs. There were also lesions present on the palms and soles. The lesions ranged in size from 5 mm to 3 cm, the largest being a verrucous exophytic nodule on the anterior aspect of her left leg. Overall, there appeared to be two distinct types of lesion. One type appeared round, oval, and symmetric with a central keratotic plug, similar to that on the ear. The other type was larger, more exophytic, and verrucous, including the lesions on the volar surfaces. Also present were numerous, irregularly shaped atrophic scars where previous lesions had healed spontaneously. There were no oral lesions or lesions on her fingernails or toenails, and her teeth and hair were normal. A biopsy was obtained from an early lesion on the right dorsal forearm. Histology revealed an exo-/endophytic growth having a central crater containing keratinous material (Fig. 2). The crater was surrounded by markedly hyperplastic squamous epithelium with large squamous epithelial cells having abundant glassy cytoplasm. Some cells were dyskeratotic. Within the dermis was a dense, chiefly mononuclear inflammatory infiltrate. A buttress of epidermis surrounded the crater. The clinical and pathologic data were consistent with keratoacanthomas. Initial laboratory screenings revealed elevated triglycerides and total cholesterol, 537 mg/dL (normal, < 150 mg/dL) and 225 mg/dL (normal, < 200 mg/dL), respectively, with all other laboratory results within normal limits. In anticipation of starting oral retinoid therapy for her multiple keratoacanthomas, she was referred to her primary care physician for control of hyperlipidemia. After her lipids had been controlled, she was placed on isotretinoin (Accutane) 40 mg/day. There was some interval improvement with regression of some lesions leaving atrophic scars. She was also started on topical application of tazarotene (Tazorac) for all nonresolving lesions. Possible side-effects from the isotretinoin occurred, including dry mouth and eyes. After 8 months of isotretinoin, the patient was switched to acitretin (Soriatane) 25 mg to determine whether it might have a more beneficial effect on the resistant lesions. Many of the larger lesions regressed leaving atrophic scars. The dose of acitretin was subsequently increased to 35 mg because the lesions on her heel and the ball of her foot persisted. Almost all of the lesions resolved, except those on her feet, which are slowly regressing. Currently, the patient is on a regimen of acitretin 25 mg once a day with tazarotene 0.1% gel applied directly to the few residual keratoacanthomas on her feet, which are slowly improving.
Collapse
Affiliation(s)
- Ron J Feldman
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | |
Collapse
|
22
|
Smith DI, Swamy PM, Heffernan MP. Off-label uses of biologics in dermatology: Interferon and intravenous immunoglobulin (Part 1 of 2). J Am Acad Dermatol 2007; 56:e1-54. [PMID: 17190617 DOI: 10.1016/j.jaad.2006.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 05/04/2006] [Accepted: 06/19/2006] [Indexed: 11/29/2022]
Abstract
The introduction of a number of biologic therapies into the market has revolutionized the practice of dermatology. These therapies include interferons, intravenous immunoglobulin, infliximab, adalimumab, etanercept, efalizumab, alefacept, and rituximab. Most dermatologists are familiar with the Food and Drug Administration-approved indications of these medications. However, numerous off-label uses have evolved. As part 1 of a 2-part series, this article will review the literature regarding the off-label uses of the interferons and intravenous immunoglobulin in dermatology.
Collapse
|
23
|
Abstract
A 56-year-old woman developed a nodule on her nose. A shave biopsy of the enlarging lesion was performed after 2 weeks and showed a keratoacanthoma. During the subsequent 4 weeks, the lesion continued to grow rapidly, and she was referred for excision of the lesion using the Mohs microscopically controlled technique. A tender 10x12 mm (120 mm2) erythematous nodule with a keratin-filled central umbilication was present on her left nasal ala (Figure 1). Treatment options were discussed. The left nasal ala was locally anesthetized with 1% lidocaine with 1:100,000 epinephrine and the keratoacanthoma was circumferentially infiltrated with 10 mg of methotrexate (0.8 mL of 12.5 mg/mL methotrexate) using a 30-gauge needle. The total amount of methotrexate injected was divided among several injection sites: the peripheral shoulder of the lesion (such that there was blanching of the entire rim) and under the center of the lesion at a depth clinically judged to be the deepest area of involvement. Within the next 7 days, the tumor began to decrease in size and ulcerate centrally. Examination 2 weeks after the initial injection showed a 71% reduction in the area of the tumor, which now measured 35 mm2 (7.0x5.0 mm). The tumor was injected in a similar manner as before with 5 mg of methotrexate. After another 2 weeks, the tumor had continued to shrink. It was flat without nodularity and measured 12 mm2 (4.0x3.0 mm); the tumor area was 66% less than 2 weeks earlier and 90% less than its original size. The residual tumor was again injected with 4.5 mg of methotrexate. There was complete clinical involution of the tumor when the patient returned for evaluation 6 weeks after her initial injection of methotrexate (Figure 2). A biopsy of the lesional area to confirm histologic resolution of the keratoacanthoma was not performed since there was no visible residual tumor. Periodic follow-up examination has been performed and there has been no subsequent recurrence of the keratoacanthoma.
Collapse
Affiliation(s)
- Philip R Cohen
- Dermatologic Surgery Center of Houston, PA, and the Department of Dermatology, University of Texas-Houston Medical School, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
24
|
Hamou S, Hochart G, Jourdel D, Martin de Lassalle E, Piette F, Rouland JF. [Giant keratoacanthoma of the eyelid]. J Fr Ophtalmol 2006; 28:1115-9. [PMID: 16395207 DOI: 10.1016/s0181-5512(05)81148-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The clinicopathologic case of a 76-year-old male with a giant tumor of the left eyelid is reported. Histopathological diagnosis was a keratoacanthoma. The lesion was treated with an injection of 5-Fluoro-Uracil and oral treatment with acitretin (Soriatane), causing the lesion to disappear quickly. Clinical and histopathological characteristics of keratoacanthoma are important to know because the differential diagnosis is epidermoid carcinoma. This treatment is original in that the surgical exeresis usually done in this kind of tumor would have been too mutilating for the eyelid in such a case.
Collapse
Affiliation(s)
- S Hamou
- Clinique Ophtalmologique Universitaire, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire, Lille.
| | | | | | | | | | | |
Collapse
|
25
|
Oh CK, Son HS, Lee JB, Jang HS, Kwon KS. Intralesional interferon alfa-2b treatment of keratoacanthomas. J Am Acad Dermatol 2005; 51:S177-80. [PMID: 15577764 DOI: 10.1016/j.jaad.2004.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Complete excision is not always easy when a keratoacanthoma is large or located in certain anatomic areas. An effective nonsurgical treatment would be desirable in such cases. OBJECTIVE This was a pilot study of the effects of intralesional interferon alfa-2b in the treatment of rapidly growing keratoacanthomas. METHODS A total of 4 large, rapidly growing keratoacanthomas, which were located on the lower lip, neck, and cheeks of the 4 different patients, were treated with intralesional interferon alfa-2b injection weekly. Serial photographs were taken to observe the course of responses. RESULTS All lesions resolved completely in 5 to 7 weeks with acceptable cosmetic results. CONCLUSION Intralesional interferon alfa-2b can be a treatment modality of these difficult lesions.
Collapse
Affiliation(s)
- Chang-Keun Oh
- Department of Dermatology, Pusan National University College of Medicine, Busan, Korea.
| | | | | | | | | |
Collapse
|
26
|
Combined 5-Fluorouracil and Er:YAG Laser Treatment in a Case of Recurrent Giant Keratoacanthoma of the Lower Leg. Dermatol Surg 2004. [DOI: 10.1097/00042728-200412020-00016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Thiele JJ, Ziemer M, Fuchs S, Elsner P. Combined 5-Fluorouracil and Er:YAG Laser Treatment in a Case of Recurrent Giant Keratoacanthoma of the Lower Leg. Dermatol Surg 2004; 30:1556-60. [PMID: 15606840 DOI: 10.1111/j.1524-4725.2004.30559.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Keratoacanthomas are fast-growing squamous tumors, which usually show spontaneous regression. The development of giant variants with an aggressive behavior has been described. Although surgical excision remains the treatment of choice for very large keratoacanthomas, other therapeutic options including laser surgery and topical chemotherapy may be superior in special situations. OBJECTIVE The objective was to evaluate the efficacy of Er:YAG laser surgery combined with topical 5-fluorouracil treatment in a case of recurrent giant keratoacanthoma. METHODS A 64-year-old woman presented for evaluation and treatment of recurrent tumors in her face and extremities. Despite repeated invasive surgical removal of these lesions, recurrence of fast-growing giant keratoacanthomas developed in the pretibial region of her left lower leg. Owing to recurrence after conventional surgery and the tumor size, a novel treatment method using ablative Er:YAG laser combined with topical 5-fluorouracil was performed. RESULTS After four treatments with excellent patient compliance, histologic analysis of punch biopsies revealed tumor-free ulcerations. Complete epithelization was obtained after 9 weeks. Six months after the treatment, no recurrence was observed. CONCLUSION The combined use of ablative Er:YAG laser and topical 5-fluorouracil chemotherapy may be considered as an effective treatment option in cases of giant keratoacanthoma when conventional surgery is not indicated.
Collapse
Affiliation(s)
- Jens J Thiele
- Department of Dermatology, Friedrich-Schiller-University of Jena, Jena, Germany.
| | | | | | | |
Collapse
|
28
|
Goldberg LH, Silapunt S, Beyrau KK, Peterson SR, Friedman PM, Alam M. Keratoacanthoma as a postoperative complication of skin cancer excision. J Am Acad Dermatol 2004; 50:753-8. [PMID: 15097960 DOI: 10.1016/j.jaad.2003.11.065] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Keratoacanthomas usually occur spontaneously as a single rapidly growing tumor on sun-exposed skin. Multiple keratoacanthomas are rarely seen. Keratoacanthomas may also develop after trauma, laser resurfacing, radiation therapy, and at the donor site after skin grafting. OBJECTIVE We report 6 cases of keratoacanthomas that developed in and around healing and healed surgical sites after treatment of skin cancer. These tumors developed 1 to 3 months after surgery and were sometimes multiple. METHODS We performed follow-up examinations of patients' wounds after the treatment of skin cancer. Histological examination of nodules developing in the margins of healing wound sites and in the scars of healed wound sites after Mohs micrographic surgery revealed keratoacanthomas. RESULTS The tumors presented as a rapidly growing nodule or nodules, with the typical morphology and pathology of keratoacanthoma. One patient developed multiple keratoacanthomas at surgical and nonsurgical sites. These nodules were treated by a combination of excision, curettage and electrodesiccation, and oral isotretinoin, 4 mg/d. CONCLUSION Keratoacanthoma must be considered in the differential diagnosis of a rapidly growing nodule within or around the surgical site after skin cancer surgery.
Collapse
|
29
|
Saito M, Sasaki Y, Yamazaki N, Shimizu H. Self-involution of giant keratoacanthoma on the tip of the nose. Plast Reconstr Surg 2003; 111:1561-2. [PMID: 12618621 DOI: 10.1097/00006534-200304010-00038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Affiliation(s)
- Edith Orion
- Dermatology Unit, Kaplan Medical Center, Rehovot, Israel
| | | | | |
Collapse
|
31
|
Tursen U, Kaya TI, Ikizoglu G. Interferon-alpha 2b induced facial erythema in a woman with chronic hepatitis C infection. J Eur Acad Dermatol Venereol 2002; 16:285-6. [PMID: 12195575 DOI: 10.1046/j.1468-3083.2002.00487_2.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
32
|
Abel EA. Skin neoplasias including cutaneous lymphoma, melanoma, and others: unapproved treatments or indications. Clin Dermatol 2000; 18:201-10. [PMID: 10742630 DOI: 10.1016/s0738-081x(99)00112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- E A Abel
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
33
|
|
34
|
Affiliation(s)
- M Kashani-Sabet
- Cutaneous Oncology Division, Department of Dermatology, University of California at San Francisco, 94115, USA
| |
Collapse
|
35
|
Affiliation(s)
- D S Hurd
- Ohio University School of Osteopathic Medicine, Department of Dermatology and Grandview Hospital and Medical Center, Dayton, USA
| | | |
Collapse
|
36
|
Abstract
BACKGROUND Keratoacanthoma is a common cutaneous neoplasm, although the persistent form is less common and often more difficult to manage. Multiple treatment approaches have been attempted with variable efficacy. Establishing the diagnosis and selecting a treatment plan for persistent keratoacanthoma is often challenging. OBJECTIVE Our purpose is to describe the difficulty one may encounter in the diagnosis and treatment of persistent keratoacanthoma. Hopefully, review of this clinical conundrum may facilitate the management of the reader's future patients. METHODS We describe a case of persistent keratoacanthoma where the diagnosis was initially elusive and the management challenging. Our thought process during each stage of diagnosis and management is described in the form of "issues" with references to the appropriate literature. RESULTS After several diagnostic and therapeutic interventions, successful treatment was achieved with administration of oral isotretinoin. Long-term remission continued as the dosage was tapered. CONCLUSION Persistent keratoacanthoma may be challenging to diagnose and manage, presenting a clinical conundrum. Careful review of the clinicopathologic presentation and an understanding of the various treatment options may result in a successful outcome.
Collapse
MESH Headings
- Administration, Oral
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Dermatologic Surgical Procedures
- Humans
- Isotretinoin/administration & dosage
- Keratoacanthoma/diagnosis
- Keratoacanthoma/drug therapy
- Keratoacanthoma/pathology
- Keratoacanthoma/surgery
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/drug therapy
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Skin/pathology
- Skin Neoplasms/diagnosis
- Skin Neoplasms/drug therapy
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Treatment Outcome
Collapse
Affiliation(s)
- G C Canas
- Department of Dermatology, University of Iowa Hospitals, Iowa City 52242
| | | | | |
Collapse
|
37
|
Affiliation(s)
- T L Frank
- Department of Dermatology and Cutaneous Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | |
Collapse
|
38
|
de Visscher JG, van der Wal JE, Starink TM, Tiwari RM, van der Waal I. Giant keratoacanthoma of the lower lip. Report of a case of spontaneous regression. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:193-6. [PMID: 8665314 DOI: 10.1016/s1079-2104(96)80414-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The case of a 46-year-old man who refused treatment of a giant keratoacanthoma of the lower lip is presented. Complete regression took place within 10 months. The dilemma of a lesion of the vermilion border of the lower lip being either a (giant) keratoacanthoma or a squamous cell carcinoma is discussed with respect to the management of such lesions.
Collapse
|
39
|
|
40
|
Affiliation(s)
- D M Warner
- Department of Medicine, University of Florida College of Medicine, Gainesville
| | | | | |
Collapse
|
41
|
Coskey RJ. Dermatologic therapy: 1993. J Am Acad Dermatol 1994; 31:764-74. [PMID: 7929923 DOI: 10.1016/s0190-9622(94)70239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This article reviews some therapeutic results reported in the English-language literature during 1993. Readers should review the original article in full before attempting any experimental or controversial therapy.
Collapse
Affiliation(s)
- R J Coskey
- Dermatology Department, Wayne State University School of Medicine, Detroit, Michigan
| |
Collapse
|
42
|
Abstract
The keratoacanthoma is a common cutaneous neoplasm that most often occurs on sun-exposed sites in light-skinned persons of middle age or older. It is considered the prototype of cutaneous pseudo-malignancies because it is a rapidly growing tumor with a histologic pattern resembling squamous cell carcinoma. It may be best viewed as an aborted malignancy that only rarely progresses into an invasive squamous cell carcinoma. It is most likely derived from hair follicle cells. The common type of keratoacanthoma and its many variants are discussed with emphasis on clinical and histologic features, biologic behavior, and response to therapy.
Collapse
|