Talk:Keratoacanthoma

Contains plagiarised material
At the moment parts of this article are verbatim from http://emedicine.medscape.com/article/1100471-overview We need to fix this. The emedicine page isn't very good imho so it will be no loss. 60.234.221.211 (talk) 07:54, 27 January 2011 (UTC)

Cancer?
First sentence says benign, later paragraph says cancer. Most other sources say cancer. —Preceding unsigned comment added by 70.16.200.107 (talk) 22:24, 24 September 2008 (UTC)

Comments on Point of View re Benign or Malignant and What constitutes acceptable treatment —Preceding unsigned comment added by AussiePathologist (talk • contribs) 03:27, 10 May 2010 (UTC)

This article strongly states that Keratoacanthoma, believed by all the pathologists I know (in Australia, where it is very common) to be benign, is a cancer, and then it states that anything other than early surgical removal is not meeting modern standards of care. No references are given for views which do not accurately represent the worldwide perspective on diagnosis and treatment of this entity.

This may partly reflect some tendency by US pathologists to call things KA which have criteria than an Australian pathologist would automatically classify as Squamous cell carcinoma (albeit with some KA like architecture), eg abnormal mitoses and hyperchromasia with loss of polarity and infiltration (see * Reference at end of this post). Some US pathologists use the term SCC-KA for this KA-like variant of SCC, which is fine, but that does not mean that true KA does not exist - I see one every week.

As it stands the article is both unreferenced (with respect to benign versus malignant and to standard treatment) and does not indicate that there is a diversity of views and diagnostic criteria, hence it could be very confusing to any patient looking up their diagnosis.

This view should be given only as one possible view, indicating that criteria may vary from region to region, and must be supported with at least some actual references, otherwise the sections on ‘benign versus malignant’ and on treatment should both be removed.

Here is an excerpt from the well balanced Medscape article on the subject, with the references.

I am no sort of HTML expert, so I hope some more expert people can help sort this out.

Thanks,

AussiePathologist AussiePathologist (talk) 04:09, 10 May 2010 (UTC)

From Medscape (http://www.medscape.com/viewarticle/467069) :

Histologically, keratoacanthomas appear as circumscribed, keratin-filled invaginations of the epidermis with buttresses of normal epidermis and 'may be difficult to distinguish histologically from well-differentiated squamous cell carcinomas.' The histologic criteria most helpful in distinguishing keratoacanthoma from squamous cell carcinoma have been found to include the presence of an epithelial lip and sharp outline between tumor and stroma in favor of keratoacanthoma and ulceration, numerous mitoses, and marked pleomorphism or anaplasia in favor of squamous cell carcinoma.[2] Malignant transformation of keratoacanthoma has been identified histologically as a focal event in as many as one quarter of cases, affirming that these lesions must be completely removed and serially sectioned to reveal any foci of malignant transformation.[3]

Many modalities may be used successfully to treat keratoacanthomas. Given their capacity for spontaneous involution, some practitioners elect to observe them.[4] Treating these lesions may hasten their resolution and furthermore, given the capacity of some squamous cell carcinomas to mimic keratoacanthoma, there is a risk that a squamous cell carcinoma may be misdiagnosed as keratoacanthoma, leading to the possibility of continued growth and eventual metastasis. Treatment options for keratoacanthoma include surgical excision, electrodesiccation, and curettage; Mohs micrographic surgery; cryosurgery; radiation therapy; intralesional methotrexate; and intralesional 5-fluo-rouracil (5-FU).[1,5,6] While small keratoacanthomas in low-risk sites such as the trunk or extremities may be easily and effectively treated with electrodesiccation and curettage or cryosurgery, larger lesions may not respond as well to these locally destructive treatments.[7] Mohs micrographic surgery has been recommended for large, aggressive, rapidly growing lesions, particularly those in cosmetically sensitive areas.[6] Similarly, radiation therapy offers the potential for cure without requiring surgery or the need for reconstruction and has also been used as an adjunctive treatment following sur-gery.[5,8] Intralesional methotrexate and 5-FU have also been recommended for extensive lesions or lesions in more cosmetically sensitive areas, with advantages of intralesional methotrexate over 5-FU including decreased number of patient visits and injections, decreased pain, and lower cost.[5] If response to either of these medications does not occur, prompt and complete excision of the lesion with histologic evaluation by a dermatopathologist is recommended.

Excisional surgery is the treatment of choice for most solitary keratoacanthomas. The advantages of surgical excision include rapid treatment and availability of a complete specimen for histologic examination.[1] This treatment option is especially useful for well-cir-cumscribed lesions in anatomic sites like the arm, where there is freely movable tissue, and when quick healing within 1-2 weeks is of prime concern.[9] For squamous cell carcinomas less than 2 cm in size not occurring on the scalp, ears, eyelids, lips, or nose and not involving subcutaneous fat, it has been found that 4mm margins of clinically normal skin are generally adequate, while a 6-mm margin is recommended for tumors greater than 2 cm in diameter at low-risk sites including the trunk or extremities or greater than 1 cm in diameter at high-risk sites including the face and scalp.[10] Because there is considerable histologic overlap between keratoacanthomas and well-differenti-ated squamous cell carcinoma and malignant transformation of keratoacanthomas has been shown to occur, it would be reasonable to follow these guidelines for excisional removal of keratoacanthomas. The depth of excision should include subcutaneous fat because both keratoacanthomas and squamous cell carcinomas may extend to this level.

References 1.	Schwartz RA. Keratoacanthoma. J Am Acad Dermatol. 1994;30(1):1-19, quiz 20-22. 2.	Cribier B, Asch P, Grosshans E. Differentiating squamous cell carcinoma from keratoacanthoma using histopathological criteria. Is it possible? A study of 296 cases. Dermatology. 1999;199(3): 208-212. 3.	Sanchez Yus E, Simon P, Requena L, et al. Solitary keratoacanthoma: a self-healing proliferation that frequently becomes malignant. Am J Dermatopathol. 2000;22(4):305-310. 4.	Stranc MF, Robertson GA. Conservative treatment of keratoacanthoma. Ann Plast Surg. 1979;2(6):525-530. 5.	Melton JL, Nelson BR, Stough DB, et al. Treatment of keratoacanthomas with intralesional methotrexate. J Am Acad Dermatol. 1991;25(6 pt 1):1017-1023. 6.	Larson PO. Keratoacanthomas treated with Mohs' micrographic surgery (chemosurgery). A review of forty-three cases. J Am Acad Dermatol. 1987;16(5 pt 1):1040-1044. 7.	Kingman J, Callen JP. Keratoacanthoma. A clinical study. Arch Dermatol. 1984;120(6):736-740. 8.	Donahue B, Cooper JS, Rush S. Treatment of aggressive keratoacanthomas by radiotherapy. J Am Acad Dermatol. 1990;23(3 pt 1):489-493. 9.	An KP, Ratner D. Surgical management of cutaneous malignancies. Clin Dermatol. 2001;19(3): 305-320. 10.	Brodland DG, Zitelli JA. Surgical margins for excision of primary cutaneous squamous cell carcinoma. J Am Acad Dermatol. 1992;27(2 pt 1):241-248.

Keratoacanthomas (KAs) are composed of singularly well-differentiated squamous epithelium that show only a mild degree of pleomorphism and likely form masses of keratin that constitute the central core of keratoacanthoma. Pseudocarcinomatous infiltration in keratoacanthoma typically presents a smooth, regular, well-demarcated front that does not extend beyond the level of the sweat glands. The term SCC-KA type has been introduced for otherwise classic keratoacanthomas that reveal a peripheral zone formed by squamous cells with atypical mitotic figures, hyperchromatic nuclei, and loss of polarity to some degree. These marginal cells also may penetrate into surrounding
 * The quote below is from http://emedicine.medscape.com/article/1100471-diagnosis (may need a login to see it). No literature reference is given:


 * Here is another useful site http://www.dermnetnz.org/lesions/keratoacanthoma.html 60.234.221.211 (talk) 07:58, 27 January 2011 (UTC)

ICD-10 code incorrect
I believe it is important to specify the version of ICD-10 being used The code for Keratoacanthoma is L85.8 in ICD-10v4 - D23 may have been correct for earlier versions. — Preceding unsigned comment added by Spdegabrielle (talk • contribs) 08:32, 16 July 2013 (UTC)

Proposed merge
Hello to all! I am proposing a merge from the following articles into this article:
 * Giant keratoacanthoma
 * Keratoacanthoma centrifugum marginatum
 * Multiple keratoacanthomas
 * Solitary keratoacanthoma

This is for the following reasons:
 * These articles are very short in length (1-2 sentences) and have not been edited significantly in 3-4 years.
 * This knowledge shouldn't be obscured from readers of this article by virtue of being isolated in an obscure article of 1-2 lines.
 * These topics may receive more attention by being mentioned in the main article.
 * The articles, if needs be, could be re-expanded at a later date.

Kind Regards, LT90001 (talk) 13:36, 9 August 2013 (UTC)
 * In the absence of objections, I have merged these articles. LT90001 (talk) 02:42, 16 August 2013 (UTC)

Proposed merge (2)
Hello to all! I am proposing a merge from the following articles into this article:
 * Generalized eruptive keratoacanthoma

This is for the following reasons:
 * The main article would benefit significantly from having all this information in one place.
 * This article contains a small amount of mostly uncited information that is repeated in the main article.
 * This knowledge shouldn't be obscured from readers of this article by virtue of being isolated in an obscure article of 1-2 lines.
 * These topics may receive more attention by being mentioned in the main article.
 * The articles, if needs be, could be re-expanded at a later date.

Kind Regards, LT90001 (talk) 02:44, 16 August 2013 (UTC)

poor photo
Why is the photo so uncharacteristic of keratoacanthoma, which is usually single? — Preceding unsigned comment added by 203.217.59.229 (talk) 21:49, 26 February 2015 (UTC)