Lesión dermatológica en zona de tatuaje / Dermatological lesion in tattoo area

Los tatuajes representan una situación in vivo única en la que una gran cantidad de sales metálicas y tintes orgánicos permanecen en la piel durante toda la vida. Como resultado de un mayor número de tatuajes realizados, la incidencia de complicaciones cutáneas asociadas a los tatuajes ha aumentado también. En los últimos 30 años se ha evidenciado un aumento de reportes de tumores cutáneos en los tatuajes; sin embargo, muchos autores siguen considerándolo un evento fortuito. Los posibles efectos cancerígenos locales de los tatuajes siguen sin estar claros. Se cree que este efecto podría ser multifactorial y que combina traumatismo de la aguja, inflamación local crónica, factores externos como la exposición a los rayos ultravioleta (UV) y un posible efecto pro-cancerígeno de las tintas. Se necesitan estudios epidemiológicos y clínicos a gran escala para demostrar esta asociación. Se presenta un caso de un hombre de 40 años, conocido sano, quien 2 meses después de tatuarse el hombro derecho, desarrolla una lesión con características clínicas de un queratoacantoma y a quien se le realiza el diagnostico histológico de un carcinoma espinocelular bien diferenciado e invasor.

Tattoos represent a unique in vivo situation where many metallic salts and organic dyes remain on the skin for a lifetime. As a result of a greater number of tattoos performed, the incidence of skin complications associated with tattoos has increased. In addition, in the last 30 years, there has been an increment in reports of skin tumors within tattoos; however, many authors continue to consider it is a coincidental event. The possible local carcinogenic effects of tattoos remain unclear. It is believed that this effect could be multifactorial, combining needle trauma, chronic local inflammation, external factors such as an ultraviolet rays (UV) exposure and a possible pro-cancer effect of the inks. Large-scale epidemiological and clinical studies are needed to demonstrate this association. A case of a known healthy 40-year-old male is presented, in whom 2 months after a tattoo was performed on his right shoulder, he developed a lesion with clinical characteristics of a keratoacanthoma in which the histological diagnosis of a well differentiated and invasive squamous cell carcinoma was made.

Case for diagnosis. A pruritic eruption of keratotic papules over the face and neck

Abstract Generalized eruptive keratoacanthoma of Grzybowski is a rare variant of multiple keratoacanthomas counting with about 40 cases reported. It is a chronic and progressive disease for which none of the described therapeutic options has been entirely satisfactory. We report a case of an 83-year-old female who presented with a 3-month history of extremely pruritic, multiple, skin-coloured to erythematous to brownish, millimetric papules, with a keratotic centre. Histological examination of an incisional biopsy was consistent with the diagnosis of keratoacanthoma. The patient started acitretin 25 milligrams daily with a complete resolution of pruritus and regression of numerous lesions.

Queratoacantoma tratado con metotrexato intralesional: una alternativa terapéutica efectiva en casos seleccionados / Keratoacanthoma treated with intralesional methotrexate: an effective therapeutic alternative in selected cases

El Queratoacantoma es un carcinoma de células escamosas de rápido crecimiento, cuyo tratamiento definitivo contempla la resección quirúrgica. El manejo se dificulta cuando las condiciones de la lesión implican cirugías extensas o las condiciones del paciente son riesgosas al plantear manejo invasivo. Se propone el uso de Metotrexato intralesional como estrategia terapéutica alternativa al tratamiento quirúrgico tradicional. Se exponen 2 casos en los cuales se usó este método. Primero es una paciente de 91 años con queratoacantoma en región frontal, de rápido crecimiento. Segundo, un paciente de 76 años, en tratamiento anticoagulante, con lesión en cuero cabelludo. Ambos pacientes reciben inyecciones de Metotrexato, las cuales muestran resultados significativos, en cuanto a reducción de tamaño. La inyección intralesional de Metotrexato demuestra utilidad como alternativa terapéutica o como manejo neoadyuvante previo a la cirugía

Keratoacanthoma is a rapidly growing squamous cell carcinoma, which definitive treatment includes surgical resection. Therapy becomes more complex when the lesion requires extensive surgeries or the patient's conditions are risky for invasive management. The use of intralesional methotrexate is proposed as an alternative therapeutic strategy to traditional surgical treatment. Two cases are presented where this method was used. First a 91-year-old patient with rapidly growing keratoacanthoma in the frontal region. Second a 76-year-old patient, undergoing anticoagulant treatment, with a scalp lesion. Methotrexate injections were applied to both patients, with significant lesion size reduction. Intralesional injection of Methotrexate proves useful as a therapeutic alternative or as neoadjuvant management prior to surgery.

Eruptive Keratoacanthoma en Plaque Confirmed by Complete Spontaneous Regression: A Case Report and Review of the Literature / 대한피부과학회지

Here we present a case of an unusual variant of keratoacanthoma, eruptive keratoacanthoma en plaque, occurring on the upper lip of a 58-year-old man. The lesion was a flesh-colored nodular plaque measuring 1.5×1.0 cm that rapidly grew within 2 months. After two biopsies, the cutaneous lesion grew more rapidly for 1 month, covering the entire cutaneous surface of the upper lip and measuring 6.0×2.0 cm. Thereafter, it disappeared without any treatment within 3 months, resulting in mild scarring with a cobblestone-like surface similar to the stereotypical involuting course of ordinary keratoacanthoma. In addition to the clinical features, the present case displayed essential diagnostic features of eruptive keratoacanthoma by showing typical spontaneous involution not reported in previous reports. Furthermore, it also revealed histopathology suggestive of squamous cell carcinoma, at least focally in addition to that of keratoacanthoma, which may evoke the potential for a misdiagnosis of malignancy.

Ceratoacantoma: aspectos morfológicos, clínicos e cirúrgicos / Keratoacanthoma: morphological, clinical, and surgical aspects

Introdução: O ceratoacantoma é uma neoplasia epitelial de rápido crescimento, mais frequente em áreas de exposição solar. Habitualmente, apresenta-se como lesão única, arredondada, com depressão central preenchida de queratina. As semelhanças clínicas e histopatológicas com o carcinoma de células escamosas, frequentemente, dificultam o diagnóstico diferencial. A biópsia excisional é a abordagem de escolha, permitindo diagnóstico e tratamento. Método: O presente estudo é observacional e retrospectivo, com dados de 162 pacientes tratados de 2005 a 2013, no Hospital Felício Rocho, em Belo Horizonte, MG. Todos os pacientes submeteram-se à excisão cirúrgica dos tumores. Foram estudados: sexo, idade, número de lesões, localização, tamanho do tumor e diagnóstico pré-operatório. Resultados: Dos 162 pacientes, totalizando 173 lesões, 154 (95,06%) apresentavam ceratoacantoma único. Noventa e dois eram do gênero masculino (56,80%) e 70 do feminino (43,20%). A idade dos pacientes variou de 11 a 96 anos, com média de 71,23 anos. As lesões localizavam-se predominantemente nos membros superiores (43,64%), na face (28,48%) e nos membros inferiores (17,58%). Nas hipóteses diagnósticas formuladas pelos cirurgiões, no pedido do exame anatomopatológico, houve diagnóstico correto em 63,13%. Conclusão: O ceratoacantoma é uma neoplasia epitelial de características morfológicas semelhantes ao carcinoma de células escamosas, o que, por muitas vezes, dificulta o diagnóstico. Torna-se necessária, portanto, a excisão cirúrgica completa das lesões suspeitas para diagnóstico e tratamento corretos.

Introduction: Keratoacanthoma is an epithelial neoplasm of rapid growth, more frequent in areas of sun exposure, and usually appears as a single, rounded lesion with a central depression filled with keratin. Clinical and histopathological similarities with squamous cell carcinoma often make differential diagnosis difficult. Excisional biopsy is the approach of choice, allowing diagnosis and treatment. Method: This is an observational and retrospective study, in which data of 162 patients treated at the Hospital Felício Rocho from 2005 to 2013, in Belo Horizonte, MG, were analyzed. All patients underwent surgical excision of tumors. Data on sex, age, number of lesions, location, tumor size, and preoperative diagnosis were studied. Results: Of the 162 patients, with a total of 173 lesions, only 154 (95.06%) had keratoacanthoma. There were 92 male (56.80%) and 70 female (43.20%) patients. The age of patients ranged from 11 to 96 years, with an average of 71.23 years. The lesions were located predominantly in the upper limbs (43.64%), face (28.48%), and lower limbs (17.58%). In the diagnostic hypotheses formulated by surgeons at the request of the pathology, the diagnosis was correct in 63.13%. Conclusion: Keratoacanthoma is an epithelial tumor with morphological characteristics similar to those of squamous cell carcinoma, which often complicates the diagnosis. Therefore, the complete excision of the suspicious lesions is necessary for correct diagnosis and treatment.

Various Skin Tumors Originating from Disseminated Superficial Actinic Porokeratosis / 대한피부과학회지

Disseminated superficial actinic porokeratosis (DSAP) is a rare keratinization disorder. It is histopathologically characterized by the presence of coronoid lamellae and clinically by lesions showing central atrophy with elevated borders. Squamous cell carcinoma originating in the classical Mibelli subtype of porokeratosis is well-documented; however, few reports have described squamous cell carcinoma in DSAP lesions. We report the case of a 76-year-old woman with DSAP who developed Bowen's disease, actinic keratosis, and keratoacanthoma on her face.

Reconstruction of surgical defect of the dorsum of the hand

Abstract In some cases, keratoacanthomas can be indistinguishable from squamous cell carcinoma, making the gold standard treatment surgical excision with histopathological evaluation. The surgical defects created on the back of the hand can be challenging to repair. We describe the use of bilateral rotation flap as an option in this area, and discuss the indications and contraindications of some of the possible surgical techniques for reconstruction of the dorsum of the hand.

Multiple Giant Keratoacanthoma Treated with Acitretin / 대한피부과학회지

Giant keratoacanthoma is an uncommon variant of keratoacanthoma, which may increase to a diameter of several centimeters. Although keratoacanthomas usually resolve spontaneously, giant keratoacanthoma can be invasive and destructive. A 49-year-old man presented with a 5-year history of multiple large hyperkeratotic and crusted plaques and nodules on sun-exposed areas such as the face, ear, hand, and forearm. Some lesions involuted spontaneously, whereas others became rather enlarged. The biopsy specimen revealed horn-filled crater formation, epidermal extending resembling a buttress, and an eosinophilic glassy appearance in the keratinocytic cytoplasm. We treated the lesions with acitretin, and they almost completely resolved after 13 weeks. Here we describe a case of multiple giant keratoacanthoma treated with acitretin.

A Case of Squamous Cell Carcinoma Occurred in the External Auditory Canal Misdiagnosed as a Keratoacanthoma after Radiotherapy for Kimura's Disease / 대한이비인후과학회지

Malignancy of the external auditory canal (EAC) is a rare tumor. Among the malignancies of EAC, squamous cell carcinoma (SCC) is the most common pathologic type. The causes of SCC of EAC may be exposure to ultraviolet rays, cholesteatoma, chronic otitis externa, and rarely radiotherapy. SCC of EAC has the diverse and non-specific clinical features including mass of tissue, otorrhea, otalgia, tinnitus, and facial palsy which make it difficult to distinguish between SCC and benign tumor. Recently, we experienced a case of SCC of EAC occurred in the left external auditory canal after radiotherapy for Kimura's disease, which was misdiagnosed as keratoacanthoma at first. The findings of this case suggest that when it is difficult to distinguish SCC from benign tumor of EAC, the excisional biopsy including enough resected margin and base of tumor is needed for an exact diagnosis.

A Case of Exophytic Pilomatricoma Clinically Resembling Keratoacanthoma

No abstract available.

Keratoacanthoma of the conjunctiva in a young patient / Ceratoacantoma da conjuntiva em um paciente jovem

ABSTRACT Keratoacanthomas rarely occur in the conjunctiva. We report a case of a 24-year-old man with a rapidly growing conjunctival mass. The tumor was excised with a safety margin to exclude squamous cell carcinoma and was histopathologically diagnosed as a keratoacanthoma. There has been no recurrence over 2 years of follow-up. To the best of our knowledge, he is the youngest patient to be diagnosed with conjunctival keratoacanthoma who had no known risk factors such as skin disorders, trauma, surgery, or infection. In similar cases, we recommend complete early surgical excision and careful follow-up to exclude malignancy.

RESUMO Ceratoacantoma raramente ocorre na conjuntiva. Nós relatamos o caso de um homem de 24 anos de idade, com uma massa conjuntival de rápido crescimento. O tumor foi retirado com uma margem de segurança para excluir carcinoma de células escamosas. Ele foi diagnosticado histopatologicamente como sendo ceratoacantoma. Não houve recidiva em dois anos de seguimento. Ele é o paciente mais jovem com ceratoacantoma conjuntival que não tinham fatores de risco conhecidos como doenças de pele a ser descrito. Em casos semelhantes, recomendamos excisão cirúrgica precoce completo e um acompanhamento cuidadoso para excluir malignidade.

Síndrome de Lynch variante Muir-Torre: a propósito de 2 casos / Lynch syndrome, Muir Torre variant: 2 cases

El síndrome de Lynch (SL), es un síndrome genético con patrón de herencia autosómico dominante, que predispone el desarrollo de cáncer colorrectal y neoplasias extracolónicas, debido a la mutación germinal en alguno de los genes reparadores de los errores de la replicación del ADN (MLH1, MSH2, MSH6 o PMS2). El Síndrome de Muir-Torre (SMT), es una variante fenotípica del SL que predispone además a desarrollar tumores de glándulas sebáceas y queratoacantomas. Presentamos el caso de dos pacientes con SMT, con más de una neoplasia relacionada al SL, lesiones cutáneas, antecedentes familiares de cáncer y estudios de inestabilidad de microsatélites e inmunohistoquímica...

Lynch syndrome (LS) is an autosomal-dominant inherited cancer predisposition syndrome caused by germline mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6 or PMS2). Muir-Torre syndrome (MTS) is a phenotypic variant of LS that includes a predisposition to sebaceous glands tumors and keratoacanthomas. We report two patients with MTS, with more than one LS-related cancer, skin lesions, family history of cancer andmicrosatellite instability and immunohistochemistry analysis...

A Clinical Investigation of Cutaneous Malignant Tumors in Western Gyeongnam Province over 11 Years / 대한피부과학회지

BACKGROUND: The incidence rates of cutaneous malignant tumors in the Korean population are increasing. However, few clinical studies have been conducted on cutaneous malignant tumors in Gyeongnam Province. OBJECTIVE: The purpose of this study was to evaluate the prevalence of cutaneous malignant tumors in Western Gyeongnam Province and to compare the results with previous reports of cutaneous malignant tumors. METHODS: We retrospectively reviewed 46,277 outpatients who visited the Department of Dermatology from January 2005 to December 2015. Among them, 1,120 patients who underwent biopsy for skin tumors had tumors classified as cutaneous malignant tumors. We compared the histopathological diagnoses and analyzed the distribution of dermatologic diseases and clinical features, including age and sex. RESULTS: The mean age of the patients was 70.0 years. The ratio of male to female patients was 1：1.85. Cutaneous malignant and premalignant tumors were found in 2.4% of all new patients. The most common disease was basal cell carcinoma (39.6%), followed by squamous cell carcinoma (31.5%), malignant lymphoma (6.3%), metastatic carcinoma (5.8%), keratoacanthoma (4.2%), malignant melanoma (4.1%), and extramammary Paget's disease (2.8%). The most common premalignant tumor was actinic keratosis (73.2%), followed by Bowen's disease (26.8%). The most common site of cutaneous malignant tumors and premalignant tumors was the face (75.3% and 80.8%, respectively). CONCLUSION: This study provides useful data on the incidence and characteristics of cutaneous malignant tumors. The frequency of malignant tumors was higher than that found in previous studies.

Multiple Epidermal Cysts in a Hepatocellular Carcinoma Patient Taking Nexavar® / 대한피부과학회지

An epidermal cyst is a keratin-filled lesion lined by an epidermis and presents as a single or multiple intradermal or subcutaneous mass. Sorafenib (Nexavar®, BAY 43-9006) is a tumor angiogenesis inhibitor that is used for treatment of hepatocellular and renal cell carcinomas. Sorafenib can cause a variety of cutaneous toxicities-hand-foot skin reaction (HFSR) and non-hand-foot skin reaction (non-HFSR). Symptoms of HFSR include paresthesia, tingling, burning or painful sensations of both palms and soles, and a decreased tolerance to hot objects. Non-HFSR cutaneous toxicities include yellow discoloration of the skin, alopecia, stomatitis, subungual splinter hemorrhages, facial swelling, keratoacanthomas, leukocytoclastic vasculitis, genital lesions, facial erythema, nevi, lentigenes, epidermal inclusion cysts, xerosis, etc. To our knowledge, the occurrence of epidermal cysts after sorafenib intake is very rare and has not yet been reported in Korea. Herein, we report a rare case of a hepatocellular carcinoma patient with multiple epidermal cysts following sorafenib intake.

Synchronous Occurrence of Primary Cutaneous Anaplastic Large Cell Lymphoma and Squamous Cell Carcinoma

CD30+ lymphoproliferative disorders (LPD) represent a spectrum of T-cell lymphoma including lymphomatoid papulosis and anaplastic large cell lymphoma (ALCL). Epidermis overlying cutaneous CD30+ LPD often shows epidermal hyperplasia, hyperkeratosis, crusting, and ulceration and it is difficult to distinguish from carcinoma such as keratoacanthoma (KA) or squamous cell carcinoma (SCC). Several cases of pseudocarcinomatous hyperplasia mimicking KA or SCC in CD30+ LPD have been reported. The relationship between CD30+ LPD and epithelial proliferations has not yet well understood. It was reported that a variety of mediators, including epidermal growth factor (EGF), transforming growth factor-α and EGFR from CD30+ LPD could attribute to epidermal hyperplasia. However, separate and distinct SCC occurring in CD30+ LPD has rarely been reported. Herein, we present a rare case of coexistence of SCC and cutaneous ALCL located on the same region.

Queratoacantoma / Keratoacanthoma

El queratoacantoma es un tumor epitelial con origen presuntivo del infundíbulo folicular. La etiología es multifactorial, siendo la exposición solar la causa de aparición clásica; se presenta con mayor frecuencia en adultos mayores. Caso clínico: Paciente femenina 83 años, dedicada al hogar, viuda, escolaridad primaria completa, originaria de Tegucigalpa, Municipio del Distrito Central. Presentó dermatosis localizada en mano derecha, que inició como pápula/nódulo eritematoso de un mes de evolución en dorso de mano la cual se convirtió en tumoración de 3cm de diámetro, con una superficie anfractuosa secundaria a un tapón de queratina; era una neoformación no fija a planos profundos, asintomática; lesión única, se encontró datos de fotodaño en el resto de la piel. En la primera evaluación se planteó un diagnóstico presuntivo de carcinoma espinocelular versus queratoacantoma. La lesión se extirpó en su totalidad hasta tejido adiposo subyacente. La pieza fue enviada al servicio de patología y se confirmó el diagnóstico histopatológico de queratoacantoma. Se estipuló que los bordes y el lecho del tejido extirpado se encontraban libres de tumor. Se dio seguimiento a la paciente al 1er, 3er, 6to y 12avo mes, sin recurrencias o lesiones nuevas. Conclusión: El queratoacantoma se confunde clínica e histopatológicamente con el carcinoma epidermoide. Es recomendable la intervención terapéutica para acelerar la resolución por motivos estéticos, y prevenir la incrustación en estructuras vitales secundaria a un crecimiento rápido...(AU)

Queratoacantoma de vulva: presentación de un caso / Vulvar keratoacanthoma: presentation of a case

El queratoacantoma de vulva es una entidad rara que podría presentar confusión en su diagnóstico con el carcinoma bien diferenciado de células escamosas. Presentamos un caso de una paciente con diagnóstico de queratoacantoma de vulva tratada con resección quirúrgica de la lesión y su seguimiento posterior.

Vulvar keratoacanthoma is a rare disease that may present confusion in diagnosis with well differentiated squamous cell carcinoma. We report one patient with vulvar keratoacanthoma, treated by resection surgery of the lesion and her outcome.

Multiple giant angiokeratoma of Fordyce on the shaft of the penis masquerading as keratoacanthoma

The term 'angiokeratoma' includes a wide range of dermatological conditions of hyperkeratotic vascular disorders with a similar histologic combination of hyperkeratosis and superficial dermal vascular ectasia. Angiokeratomas can be classified into localized and systemic forms. Angiokeratoma of Fordyce (AKF) is a localized form of angiokeratoma, clinically characterized by 1- to 6-mm, black, blue, or dark red, dome-shaped papules located on the scrotum, shaft of penis, labia majora, clitoris, inner thigh, and lower abdomen. We describe herein a case of giant angiokeratoma of Fordyce on shaft of the penis in an elderly man, clinically masquerading as keratoacanthoma.

A Giant Keratoacanthoma Treated with Surgical Excision

A keratoacanthoma is a rapidly growing cutaneous tumor that spontaneously involutes in most instances. A giant keratoacanthoma is a rare variant and are characterized by lesions larger than 20 mm in diameter. We report a 56-year-old man with a rapidly growing tumor of the right cheek, which was diagnosed as keratoacanthoma. The mass was excised completely under general anesthesia, followed by Limberg flap for reconstruction. Intraoperative frozen section histology suggested the lesion to be a well-differentiated squamous cell carcinoma, whereas final histopathology was consistent with keratoacanthoma. We herein report the first case of a giant keratoacanthoma treated with surgical excision in Korea and discuss the clinical and histopathological features of keratoacanthoma, with a review of the literature.