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Gavric G, Lekic B, Milinkovic Sreckovic M, Bosic M, Zivanovic D. Keratoacanthoma centrifugum marginatum associated with mechanical trauma: Response to acitretin-A case report and review of the literature. Dermatol Ther 2020; 33:e13397. [PMID: 32276295 DOI: 10.1111/dth.13397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/07/2020] [Indexed: 11/29/2022]
Abstract
Keratoacanthoma centrifugum marginatum (KCM) is a very rare variant of keratoacanthoma, characterized with progressive centrifugal growth, central healing, and atrophy. Due to its rarity and lack of distinctive histopathological features, KCM often raises diagnostic and therapeutic challenge. We present a case of a 76-year-old Caucasian woman with a single large tumor on her right shin that responded to oral retinoids. The patient presented history of local trauma. The tumor developed over the course of 20 months from a scar. To the best of our knowledge, this is the fifth case of KCM associated with mechanical trauma as a possible triggering factor.
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Affiliation(s)
- Goran Gavric
- Clinic of Dermatolovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Branislav Lekic
- Clinic of Dermatolovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Mirjana Milinkovic Sreckovic
- Clinic of Dermatolovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Martina Bosic
- Institute of Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dubravka Zivanovic
- Clinic of Dermatolovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, University of Belgrade, School of Medicine, Belgrade, Serbia
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Mascitti H, De Masson A, Brunet-Possenti F, Bouaziz JD, Laly P, Mourad N, Garrigues JM, Laurent-Roussel S, Cavelier-Balloy B, Moulonguet I, Leschi C, Mourah S, Bagot M, Lebbé C, Basset-Seguin N. Successful Treatment of Generalized Eruptive Keratoacanthoma of Grzybowski with Acitretin. Dermatol Ther (Heidelb) 2019; 9:383-388. [PMID: 30790235 PMCID: PMC6522604 DOI: 10.1007/s13555-019-0287-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Keratoacanthomas (KA) are common cutaneous skin tumors originating from the hair follicles. Unlike squamous cell carcinoma, KA can regress spontaneously and have a benign evolution. Solitary KA is the most common form but familial multiple KA (Ferguson–Smith type), genetically predisposed KA (such as in xeroderma pigmentosum, or Muir–Torre syndrome), or sporadic multiple eruptive KA (Grzybowski type) have been described. Generalized eruptive KA of Grzybowski (GEKA) is a rare condition (around 40 reported cases). The pathophysiology is still unclear. Human papillomavirus (HPV) has been detected in sporadic KA but the presence of HPV39 has never been reported, to our knowledge, in GEKA. Case Report GEKA in an 80-year-old woman was successfully treated with acitretin (0.5 mg/kg/day) combined with surgical removal of the largest lesions. Treatment was well tolerated and led to decreased pruritus and tumor regression within 6 months. The presence of HPV39 was detected in a lesion by polymerase chain reaction and Sanger sequencing. No genetic alteration was found, in particular in the genes usually altered in squamous cell carcinoma (including NOTCH1, NOTCH2, CDKN2A, TP53). Conclusion We report a case of GEKA associated with the presence of HPV39 and the successful use of acitretin combined with surgical removal of the larger lesions.
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Affiliation(s)
- Hélène Mascitti
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Adèle De Masson
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Florence Brunet-Possenti
- INSERM UMR-1137, IAME, Department of Virology, Bichat Hospital, University of Paris 7 Paris Diderot, Paris, France
| | - Jean-David Bouaziz
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Pauline Laly
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Nadim Mourad
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | | | - Sara Laurent-Roussel
- Department of Pathology, Saint-Louis Hospital, AP-HP, University of Paris 7 Paris Diderot, Paris, France
| | - Bénédicte Cavelier-Balloy
- Department of Pathology, Saint-Louis Hospital, AP-HP, University of Paris 7 Paris Diderot, Paris, France
| | - Isabelle Moulonguet
- Department of Pathology, Saint-Louis Hospital, AP-HP, University of Paris 7 Paris Diderot, Paris, France
| | - Cristina Leschi
- AP-HP, Saint-Louis Hospital, Department of Pharmacogenomics, INSERM UMR-S 976, University of Paris 7 Paris Diderot, Paris, France
| | - Samia Mourah
- AP-HP, Saint-Louis Hospital, Department of Pharmacogenomics, INSERM UMR-S 976, University of Paris 7 Paris Diderot, Paris, France
| | - Martine Bagot
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Céleste Lebbé
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Nicole Basset-Seguin
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France.
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Kwiek B, Schwartz RA. Keratoacanthoma (KA): An update and review. J Am Acad Dermatol 2016; 74:1220-33. [PMID: 26853179 DOI: 10.1016/j.jaad.2015.11.033] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 11/03/2015] [Accepted: 11/12/2015] [Indexed: 02/03/2023]
Abstract
Keratoacanthoma (KA) is a common but underreported tumor of the skin. Two striking features of KA are its clinical behavior with spontaneous regression after rapid growth and its nosological position on the border between benignity and malignancy. We review current knowledge on the clinical, histopathological, and dermoscopic features of KA to ensure a proper diagnosis and describe its variants, including different types of multiple KAs. We highlight current concepts of KA ethiopathogenesis with special emphasis on the genetic background of multiple familial KA, the role of Wnt signaling pathway, and induction of KA by BRAF inhibitors and procedures of esthetic dermatology. Finally, treatment strategies are presented with surgical excision as a first option, followed by other modalities, including intralesional chemotherapy, topical and systemic agents, lasers, cryotherapy, and photodynamic therapy.
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Affiliation(s)
- Bartlomiej Kwiek
- Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland.
| | - Robert A Schwartz
- Dermatology and Pathology, Rutgers University New Jersey Medical School, and Rutgers University School of Public Affairs and Administration, Newark, New Jersey
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Pattern of TGFbeta receptor 1 expression differs between kras-mutated keratoacanthomas and squamous cell carcinomas of the skin. Pathol Res Pract 2014; 210:596-602. [PMID: 24954139 DOI: 10.1016/j.prp.2014.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 04/26/2014] [Accepted: 05/15/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Increasing evidence indicates that TGFbeta- and EGFR-signaling is involved in the pathogenesis of keratoacanthoma (KA) and squamous cell carcinoma (SCC) of the skin. We analyzed the expression pattern of TGFbeta-signaling components and screened for mutations in tgfbetaR1, egfr, kras and braf in KAs and SCCs. METHODS Immunohistochemical analysis of TGFbeta1, TGFbetaR1, TGFbetaR2 and phospho-SMAD2/3 was performed on skin tumors (29 KAs, 30 well and 31 moderately differentiated SCCs). Mutation screening in hotspot regions of tgfbetaR1, egfr, kras and braf was performed through pyrosequencing of tumor DNA. FINDINGS Expression of TGFbeta1, TGFbetaR1 and p-SMAD2/3 was increased in tumors as compared to surrounding skin. In KAs characteristic strong discontinuous membranous TGFbetaR1 expression pattern frequently associated with kras mutation was noted. SCCs showed continuous TGFbetaR1 expression, stronger p-SMAD2/3 expression and less frequent kras mutations. In tumors at sun-exposed sites stronger TGFbetaR1 expression was noted. One SCC showed tgfbetaR1 mutation, but no other mutations were found. CONCLUSION Although tgfbetaR1 germline mutations cause inherited KAs and our finding of strong discontinuous membranous expression in KAs suggests accumulation of functionally altered protein, we found no tgfbetaR1 mutations or influence on TGFbeta-signaling, but frequent kras mutations in this subgroup of KAs. Characteristic TGFbetaR1 expression pattern in KA can facilitate histopathologic distinction from SCC.
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Curry JL, Torres-Cabala CA, Kim KB, Tetzlaff MT, Duvic M, Tsai KY, Hong DS, Prieto VG. Dermatologic toxicities to targeted cancer therapy: shared clinical and histologic adverse skin reactions. Int J Dermatol 2013; 53:376-84. [PMID: 23879247 DOI: 10.1111/ijd.12205] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dermatologic toxicities (DT) to targeted cancer therapy may present as inflammatory dermatoses, keratoses, and as benign and malignant squamous proliferations. METHODS Published reports of DT with cancer therapy with epidermal growth factor receptor (EGFR), tyrosine kinase (TK), MEK, PI3K, AKT, and BRAF inhibitors were reviewed. RESULTS DT associated with targeted cancer therapy demonstrated similar reactions and may be grouped as (i) DT as cutaneous inflammation, and (ii) DT as cutaneous epithelial proliferation. EGFR inhibitor, cetuximab, and MEK inhibitors, selumetinib and trametinib, demonstrated papulopustular rash with a suppurative folliculitis in 83%, 93%, and 80% of the patients on therapy, respectively. Common DT with EGFR inhibitors erlotinib and tyrosine kinase inhibitor sorafenib were hand-foot skin reactions in 30-60% of patients on therapy. PI3K inhibitor BKM-120 and AKT inhibitor MK2206 produced maculopapular eruptions seen as dermal hypersensitivity reaction on the skin biopsy. RAF inhibitors vemurafenib and sorafenib were associated with a variety of cutaneous epithelial proliferations (keratosis pilaris, seborrheic keratosis, verruca vulgaris, actinic keratosis, keratoacanthoma, and squamous cell carcinoma. CONCLUSION Various anticancer agents may target similar cellular compounds and/or cell signaling pathways thus share similar clinical and histologic features of DT. The knowledge of the overlap of DT with different types of targeted cancer therapy will assist in evaluation of cutaneous reactions.
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Affiliation(s)
- Jonathan L Curry
- Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Jacobs MS, Persons DL, Fraga GR. EGFRandMYCgene copy number aberrations are more common in squamous cell carcinoma than keratoacanthoma: a FISH study. J Cutan Pathol 2013; 40:447-54. [DOI: 10.1111/cup.12117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 01/12/2013] [Accepted: 09/29/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Melissa S. Jacobs
- Department of Pathology and Laboratory Medicine; University of Kansas Medical Center; Kansas City; KS; USA
| | - Diane L. Persons
- Department of Pathology and Laboratory Medicine; University of Kansas Medical Center; Kansas City; KS; USA
| | - Garth R. Fraga
- Department of Pathology and Laboratory Medicine; University of Kansas Medical Center; Kansas City; KS; USA
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