Combined 5-Fluorouracil and Er:YAG Laser Treatment in a Case of Recurrent Giant Keratoacanthoma of the Lower Leg

Lower lip recurrent keratoacanthoma: A case report

BACKGROUND

This paper introduces a case of recurrent keratoacanthoma (KA). KA is a self-healing disease. Recurrence after surgical resection is rare. In this case, the local application of retinoic acid ointment after the second operation achieved a good prognosis after 2 years of follow-up.

CASE SUMMARY

A 76-year-old male patient was admitted to the hospital for "lower lip rupture and scab for 3 mo". Treatment: A rectangular incision was made in the healthy tissue about 3 mm outside the periphery of the lower lip mass, and a modified Bernard sliding flap was designed to completely remove the mass. Pathology showed (lower lip) KA. When the patient returned 6 mo after surgery, the middle mucosa of the lower lip had a bulge with a diameter of about 0.5 cm. The boundary was still clear, the surface was ulcerated. A recurrence of lower lip KA was suspected and a fan-shaped incision was performed in the healthy tissue about 5 mm outside the lesion to completely resect. Pathological showed lower lip KA had recurred. Topical application of tretinoin cream was applied once a day for 3 mo. The lower lip wounds were clean at the 2-year postoperative follow-up and the mucosa was normal.

CONCLUSION

Adjuvant retinoic acid treatment after KA surgical resection can achieve good results.

Intralesional methotrexate treatment for keratoacanthoma tumors: a retrospective study and review of the literature

BACKGROUND

Intralesional methotrexate (MTX) is an effective treatment for keratoacanthoma (KA).

OBJECTIVE

We sought to systematically examine response rates and adverse events in KA treated with intralesional MTX.

METHODS

All cases of KA treated with intralesional MTX at our institution from 1991 to 2006 were identified. A MEDLINE and PubMed search of cases of KA treated with intralesional MTX was also performed.

RESULTS

In all, 38 cases of KA treated with intralesional MTX were identified: 18 from our institution and 20 from the literature. Intralesional MTX achieved resolution in 92%, requiring an average of 2.1 injections an average of 18 days apart. Adverse events were rare, with two reports of pancytopenia in patients with chronic renal failure.

LIMITATIONS

Use of single case reports, small series, and retrospective analysis are limitations.

CONCLUSION

Intralesional MTX is a useful nonsurgical therapy for the treatment of KA. Histologic diagnosis before initiation of treatment is preferred. A complete blood cell count at baseline and during treatment should be considered to monitor for potential cytopenia.