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A 79-year-old male presented for removal of what was proven to be a keratoacanthoma. Additional tissue removed deep to the initial lesion revealed intravascular basal cell carcinoma (BCC). Intravascular BCC is exceedingly rare with only 8 cases previously reported in the literature. Intravascular BCC may be associated with more aggressive subtypes. Intravascular infiltration is more common in metastatic BCC, but this finding may not imply causality. More data are required in order to determine prognostic implications of intravascular BCC and to develop a protocol for managing patients with this unique finding.

Introduction: This case report highlighting the presence of keratoacanthoma and verruca vulgaris over the lesion of porokeratosis of mibelli. Case Report: In this case a 50-year-old housewife came with large well-defined asymptomatic plaque over the upper part of back of the trunk for last 10 years. After evaluation we got the presence of keratoacanthoma and verruca vulgaris on the plaque of porokeratosis of mibelli. Discussion: Porokeratosis is a clonal expansion of keratinocytes. Among the neoplasm squmous cell carcinoma (SCC) is the most commonly reported malignancy in porokeratosis. But in our case we didn’t find lesion of SCC. Porokeratosis of Mibelli, Keratoacanthoma and Verruca vulgaris have an association with human papilloma virus(HPV). This eithopathogenesis may be related to our clinical finding. Conclusion: There were reporting of squmous cell carcinoma or keratoacanthoma on Porokeratosis of Mibelli. But in our case we found both Keratoacanthoma and Verruca Vulgaris over Porokeratosis of Mibelli. Medicine Today 2021 Vol.33(2): 172-175

Qian Ye, Ke-Jun Chen, Meng Jia, Sheng Fang Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of ChinaCorrespondence: Sheng FangDepartment of Dermatology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People’s Republic of ChinaEmail fangshengderm@163.comObjective: The aim of this study was to describe the clinical and histopathological characteristics of seborrheic keratosis (SK) with secondary tumor and identify associated factors.Methods: This study was a monocentric retrospective case-control study describing the factors associated with the development of tumors in SK. A total of 1365 patients with SK were admitted to our department between 2018 and 2021. All of the histopathological specimens and medical records of these patients were reviewed. We compared the data of 36 patients with tumors arising in SK with those of the remaining 1329 patients with only SK, which were designated the control group.Results: The incidence of tumors arising in SK that were biopsied was 2.6%. The tumor types included squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and keratoacanthoma (KA). Compared with other patients with SK, elderly patients with immunosuppression, patients presenting surrounding erythema or ulceration, and those with SK in exposed areas had an increased possibility of developing a secondary tumor. Tumors arising within SK have the histopathological features of ulceration, cytologic atypia, mitosis, “malignant horn”, trabecular cell cords, solar elastosis and severe inflammatory infiltration in the dermis.Conclusion: SK can show malignant progression in a small fraction of SK cases that are biopsied. This study is the first report on the clinical and histopathological characteristics of tumors arising in SK and identifies relevant factors in an Asian population.Keywords: seborrheic keratosis, tumor, clinical, histopathological

Background Sorafenib is an oral multikinase inhibitor that targets Raf serine/threonine receptor tyrosine kinases and inhibits tumor cell growth and angiogenesis. Cutaneous toxicities of sorafenib are common, including cutaneous eruptions (such as truncal erythema and seborrheic-dermatitis-like changes) and hand–foot syndrome. Keratoacanthomas and squamous cell carcinomas have been reported previously; however, we report a case of multiple eruptive keratoacanthomas in the form of Grzybowski syndrome after initiation of sorafenib. Case presentation We report a 63-year-old Caucasian male who developed multiple cutaneous eruptive keratoacanthomas after starting sorafenib 400 mg twice daily. He had a known history of hepatitis-C-related cirrhosis and hepatocellular carcinoma, and previously had actinic keratosis and skin squamous cell carcinoma excision. Approximately two and a half months after starting sorafenib, the patient initially developed two lesions, one on each forearm, and after excision, these lesions demonstrated histological features of squamous cell carcinoma. One month later, the patient presented with approximately 48 new skin lesions of varying size on the back, bilateral upper limbs, and face requiring excisional biopsy of a large number of these lesions. Histopathology showed eruptive invasive keratoacanthomas (Grzybowski syndrome). Sorafenib was temporarily stopped and subsequently restarted at a lower dose. Acitretin 25 mg daily was commenced after few weeks, and no further keratoacanthomas developed during his treatment. Conclusions We report a unique case of sorafenib-associated Grzybowski syndrome. Temporary interruption and dose reduction of sorafenib and use of acitretin appeared to prevent further development of keratoacanthomas.

This case discusses a 62-year-old woman with de novo metastatic lung adenocarcinoma (PD-L1 >50% with a KRAS G12C mutation, ALK and EGFR negative) who was on pembrolizumab for 1 year without any significant toxicity, only low-grade dermatitis and hypothyroidism. She was transitioned to pembrolizumab every 6 weeks at 4 mg/kg and began to develop oral sores shortly thereafter. The sores proved refractory to nystatin and mouth rinses containing corticosteroids, and the patient was ultimately diagnosed with autoimmune-triggered lichen planus. Unfortunately, her symptoms also proved refractory to typical treatments for lichen planus and worsened to the point where she began to develop cutaneous lesions and difficulty swallowing. Unfortunately, she also developed a keratoacanthoma that required excision. The pembrolizumab was stopped, and the patient’s symptoms improved with 5 days of systemic prednisone, metronidazole, and triamcinolone oral paste. Her NSCLC remains stable off active treatment for 6 months. This case study is on rare auto-immune toxicity as well as a keratoacanthoma from anti-PD-(L) 1 blockade, accompanied by sustained treatment response after cessation of the offending drug.

Collision tumors consisting of melanoma and squamous cell carcinoma are very rare. We present the case of a deceptive hyperkeratotic nodule on the forearm of a 72-year-old woman, which clinically appeared to be a squamous cell carcinoma, keratoacanthoma type. Histological examination surprisingly revealed a coexisting epithelioid melanoma. Thus, this case report shows the importance of an early histopathological and immunohistochemical workup to prevent unnecessary diagnostic and therapeutic delay with negative effects on prognosis.

Meng Jia, Feng-Zeng Li, Qian Ye, Ke-Jun Chen, Sheng Fang Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Sheng FangDepartment of Dermatology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People’s Republic of ChinaEmail fangshengderm@163.comBackground: Heat shock proteins (HSPs), a group of heat stress proteins, are characterized by highly conserved properties. Malignant transformation is a cellular stress, and the expression of HSPs may be affected during this process. Heat shock protein 105 (HSP105) is a protective protein that has long been observed in many cancer types, but little attention has been given to cutaneous squamous cell carcinoma (CSCC). As such, the objectives of this study were to observe the expression of HSP105 on CSCC and evaluate its correlation with clinicopathological characteristics.Methods: This retrospective study enrolled 60 patients with CSCC. The patients’ clinical data, including sex, age, tumor location, tumor type, and degree of pathological differentiation, were collected. The expression of HSP105 was measured by Western blot and immunohistochemical staining.Results: HSP105 expression was decreased in CSCC (HSCORE=0.65 (0.30, 1.98)) compared with normal skin (HSCORE=2.20 (1.50, 2.80)) (P< 0.001). These results were consistent with the Western blot analysis. HSP105 immunostaining of Bowen disease (HSCORE=1.28 (1.08, 2.40)) revealed higher expression than in verrucous carcinoma (HSCORE=0.30 (0.23, 0.85)), keratoacanthoma (HSCORE=0.53 (0.29, 0.93)) and acantholytic squamous cell carcinoma (HSCORE=0.53 (0.41, 0.68) (P< 0.01)). Poorly differentiated CSCC showed significantly higher expression of HSP105.Conclusion: Our study reveals for the first time that the expression of HSP105 is decreased in CSCC. We suggest that the molecular mechanisms underlying the differential expression of HSP deserve a more rigorous future study, the results of which might explain its role in carcinogenesis and its potential as a target for selective tumor therapy.Keywords: heat shock protein 105, cutaneous, squamous cell carcinoma, expression

Keratoacanthoma (KA) and well-differentiated cutaneous squamous cell carcinoma (cSCC) are hardly distinguishable clinically and histologically. They both can be seen in patients with hereditary non-polyposis colorectal cancer (HNPCC) or Lynch Syndrome, corresponding to DNA microsatellite instability. In our case, a young man had the excision of two rapidly growing skin tumours for which distinction between KA and cSCC was initially clinically and pathologically challenging. The diagnosis of well-differentiated cSCCs was made and the patient was treated with surgery. Ten years after the first cSCC, he was diagnosed with Muir-Torre syndrome, a variant of Lynch syndrome, with an heterozygote mutation of the MSH2 gene. This later diagnosis allowed to screen his family members for the same mutation and to adopt an appropriate follow-up regarding the risk of digestive tumours for him and his family. Furthermore, it is important to know that, in case of non-resectable cSCC occurring in this patient, immunotherapy using anti-PD1 antibody would probably be effective due to the known increased immunogenicity of MMR deficient tumours.

Programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have demonstrated their efficacy in the treatment of various malignancies. Despite their benefits, their immunomodulatory activities can cause unpredictable cutaneous adverse events (CAE). This study aimed to identify characteristics of CAE in patients treated with PD-1/PD-L1 inhibitors through the medical records, photographs, and pathology reports. Fifty CAE occurred in 47 (2.75%) of 1711 patients treated with PD-1/PD-L1 inhibitors. Pruritic, psoriasiform, urticarial, and acneiform eruptions were the four most common types. Melanoma patients showed CAE more frequently than other malignancies. Acneiform eruption occurred more often at ages under 60 years. Urticarial eruption appeared earlier, while keratoacanthoma appeared later after immunotherapy. The overall survival times were not significantly different between the two groups with and without CAE by Kaplan-Meier analysis (p = 0.055). Studies on CAE may provide more information to understand these drugs and to help manage the patients.

Introduction Development of singular keratoacanthoma (KA) is generally considered a benign condition as it has a tendency to regress spontaneously in spite of histological similarity to squamous cell carcinoma. Most KAs undergo excision to rule out differential diagnoses. Several alternative treatment modalities (keratinolytic, ablative, immunomodulating, antiproliferative, or targeted therapy) have been described in the past with varying success, underlining the therapeutic challenges associated with large or multiple lesions. Isomorphic response (Koebner phenomenon) may limit the efficacy of ablative options, and comorbidity may limit the use of systemic treatments. Less aggressive topical immunomodulatory treatment options represent an alternative with varying therapeutic success. Case Report Here, we describe the clinical course of a 51-year-old male patient with terminal kidney disease who suffered from the rare benign pruritic condition of Grzybowski’s generalized eruptive keratoacanthomas (GEKA) and experienced a significant reduction of lesions and symptoms upon topical therapy with imiquimod 5% cream and lapacho tea dressings alike. Conclusions Very little is known about the potential antiinflammatory or antiproliferative effects on the epidermis of the popular phytotherapeutic agent lapacho tea. More studies are warranted considering both the etiology and treatment of GEKA and topical use of phytotherapeutics in dermatology in general. Management of large or multiple KAs remains challenging.

Differentiating cutaneous diseases that mimic each other clinically and histopathologically can at times be a challenging task for the dermatopathologist. At the same time, differentiation of entities with overlapping features may be crucial for patient management. Although not seen in normal skin, plasmacytoid dendritic cells usually infiltrate the skin in several infectious, inflammatory/autoimmune and neoplastic entities. Plasmacytoid dendritic cells can be identified in tissue using specific markers such as CD123 and/or blood-derived dendritic cell antigen-2. Plasmacytoid dendritic cells are the most potent producers of type I interferons and their activity may therefore be assessed indirectly in tissue using human myxovirus resistance protein A, a surrogate marker for type I interferon production. In recent years, accumulating evidence has established the utility of evaluating for specific plasmacytoid dendritic cell-related parameters (plasmacytoid dendritic cell content, distribution and clustering and/ or human myxovirus resistance protein A expression) as a diagnostic tool in differentiating cutaneous diseases with overlapping features such as the alopecias, lupus and its mimics, and neoplastic entities. In this review, we provide an update on the current evidence on this topic and on the contexts where this can be a useful adjunct to reach the histopathological diagnosis.

Keratoacanthoma (KA) is a low grade, rapidly growing skin tumor which is thought to originate from the pilosebaceous unit from hyperkeratosis of the infundibulum and are often thought to originate on hair bearing skin or sun exposed surfaces. There are very scarce reports demonstrating they may occur in other areas such as mucous membranes or soles of the feet. We present a rare case of palmar KA in a 65-year-old female with no known antecedent history. Surgical excision was performed with complete removal of the tumor. Following surgical excision, the pathology of the irregularly elevated 0.7 x 0.2 cm lesion revealed a keratoacanthoma. The patient remained without evidence of recurrence at one year follow-up. We believe there is only one other report of isolated palmar KA to date in the literature. We review relevant literature on hand KA.

FNAC is commonly used in endocrinology, otorhinolaryngology and other areas, especially for evaluation of thyroid nodules, head and neck masses, enlarged lymph nodes and salivary gland abnormalities. Although FNAC is not a common practice in dermatology routine, in this prospective study, ninety-eight patients presenting with palpable lesions were submitted to FNAC and biopsy at the same time. The majority of cases (82 patients) were diagnosed as basal cell carcinoma on cytology, and had 100% of agreement with histopathology. Three cases presented as insufficient material in FNAC and all of them were diagnosed as superficial basal cell carcinoma in histopathology. All cases of squamous cell carcinoma (6 patients) were diagnosed accurately by FNAC. Two cases in our series were diagnosed as keratoacanthoma and due to the clinical correlation with cytopathology the report addressed this compatibility in a note; without the clinic it would be impossible to infer this diagnosis. All four cases of molluscum contagiosum showed characteristic cytopathological aspects and also had 100% of agreement with histopathology. The main potential use appears to be fastest results and confirmation of clinical diagnosis of basal cell carcinoma and squamous cell carcinoma to allow immediate referral for surgery. FNAC could also prove itself useful when the clinical diagnosis of molluscum contagiosum is among the clinical hypotheses, allowing to confirm it by viewing the characteristic intracytoplasmic inclusion bodies (molluscum bodies, or Henderson-Paterson bodies). The number of repeat out-patient clinic attendances could thus be reduced and valuable time saved on biopsy lists.

Keratoacanthomas (KAs) are fast-growing tumors and can be difficult to distinguish from squamous cell carcinomas (SCCs). Most KAs are sporadic, but KAs may also arise following traumatic procedures. We report the case of a 94-year-old male who developed multiple KAs following surgical excision of an SCC on the right lower extremity. The patient declined additional procedures including biopsy, surgery, or intralesional therapy. He was started on 5% topical FU using a 2 week on, 2 week off regimen for 16 weeks with resolution of disease. No recurrence was noted at 13 months. Topical 5-FU is a conservative, non-invasive treatment for post-traumatic KAs that is particularly suitable in the elderly, in whom the risks and morbidity from surgical or other non-invasive approaches are worth considering.

Background Surgical excision is the paradigm treatment option for non-melanoma skin cancer (NMSC), however intralesional fluorouracil (IL 5-FU) is an efficacious alternative and superior to other chemotherapy agents in NMSC. Yet, little summative data exists on the topic. Objective To assess the efficacy of IL 5-FU in the treatment of NMSC. Methods and materials A systematic review was performed using PubMed, Embase and Web of Science databases. 19 studies were included. ANOVA test was used to compare the duration of lesion prior to therapy and resolution time following IL 5-FU treatment. A two-way proportion test was performed to compare the clearance rate between squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and keratoacanthoma (KA). Results There was no significant difference between the clearance rate of SCC and BCC after IL 5-FU therapy (87 % vs 91.4%, respectively; P=0.2); however, the clearance rate of both SCC and BCC was significantly greater than that of KA (74.5%; Pl0.007); 95% CI [2.56%n19.1%]. Lesion duration and resolution time did not significantly differ across SCC, BCC, and KA (Pg0.3). Conclusion While majority of data is derived from individual cases, IL 5-FU achieved higher clearance rate in SCC and BCC groups than in KA group. J Drugs Dermatol. 2021;20(2):192-198. doi:10.36849/JDD.2021.5518.

Background Keratoacanthoma is a common cutaneous neoplasia in humans that most often occurs on sun exposed sites and is considered a rapidly growing pseudomalignancy, resembling squamous cell carcinoma. Case description Beak keratoacanthomas were diagnosed in two birds from two different households: in a 10-year-old male and in a 1-year-old male budgerigar (Melopsittacus undulatus). The main clinical findings in both birds were hyperkeratotic lesions on and around the beak caused by Knemidocoptes spp. mites and a mass formation on the side of the lesions. Both masses were solid red, ulcerated, and would bleed easily. Histology results revealed invasive epithelial neoplastic changes with centripetal keratin formation resembling epithelial keratoacanthomas that were formed due to the extensive epithelial damage. Both birds died from profuse hemorrhaging from the well-vascularized tumor. No keratoacanthoma formations were observed in the female cage mates. Conclusions and case relevance In the two cases described in this report keratoacanthomas developed in animals with extensive skin lesions caused by Knemidocoptes spp. infection. Further studies are warranted to confirm the association between these disorders.

We report on a 39-year-old man who presented with seven skin lesions on the right thigh 3 weeks after receiving a large tattoo which included red and black pigments. Initially, the lesions grew fast, later their growth stabilized. Histopathology showed well-circumscribed symmetric tumors with a central keratin-filled crater along with further trademarks of a keratoacanthoma. The patient had previously had multiple tattoos with no history of similar lesions. PCR analysis of one of the lesions revealed the presence of human papillomavirus 6. All lesions were excised with a safety margin. A 3-month follow-up revealed no further lesions.

Introduction: Lesions from cutaneous portion of eyelid account for the considerable number of ocular specimens sent to the histopathology laboratory for evaluation. Wide spectrum of lesions ranging from non-neoplastic to neoplastic lesions can arise from different tissues of eyelid. Aim: The aim of our study was to categorise the Neoplastic lesions, evaluate the prevalence of tumors and to compare with epidemiological data. Materials and Methods: Retrospective analysis of 774 consecutive cases of Eyelid tumors over a period of 5 years was carried out in tertiary health care system through histopathological confirmation. Results: A total of 774 eyelid tumors consisted of 718 Benign lesions (92.76%) and 56 Malignant lesions (7.24%). Benign tumors were common in the fifth decade with female predominance affecting upper eyelid. Maximum number of Benign tumors were 318(44.28%) cases of Cystic lesions followed by 135(18.8%) Melanocytic lesions and 126(17.54%) cases of Epithelial proliferations. Malignant tumors were predominant in seventh decade with female preponderance and preference for lower eyelid. Sebaceous gland carcinoma 24(42.85%) was the commonest malignant tumor followed by 18(32.14%) Basal cell carcinoma, 5(8. 92%) Squamous cell carcinomas and 4(7.14%) cases of Malignant melanomas. An interesting case of Squamous cell carcinoma arising from Pilomatricoma was also seen. Rare tumors noted were 3 cases of Keratoacanthoma and one each case of Merkel cell carcinoma and Non -Hodgkin’s lymphoma. Conclusion: Benign tumors comprise majority of eyelid tumors. A high index of suspicion for malignant lesion will enable the patients for early diagnosis and management with the better prognosis of these tumors. Keywords: Basal cell carcinoma, Malignant melanoma, Pilomatricoma, Sebaceous gland carcinoma, Squamous cell carcinoma.

In this article we summarized etiopathogenesis and clinical data, presented classification and described diagnosis challenges. One of the most common epithelial tumors, keratoacanthoma (KA) is characterized by rapid growth, histopathological features of squamous cell skin cancer and spontaneous regression tendency. Differential diagnosis of typical and atypical KA can be challenging since an early stage atypical KA may present similar to typical KA. Immunomorphological and immunohistochemical methods are particularly relevant for detecting atypical KA, making it possible to reliably differentiate it from squamous cell skin cancer. Years of experience in the management of KA patients, as well as foreign researchers data, suggest that the treatment approach should be based on the differentiation of clinical features of a typical KA from an atypical one.This report describes a clinical case of a giant keratoacanthoma.

Background: Skin adnexal tumours are a category of rare tumours. They usually present as painless nodules and papules. The diagnosis of these tumours poses a challenge, because there is usually a discrepancy in clinical and histopathological diagnosis. Aims: To study the skin biopsies received in our department and compare their clinical and histopathological diagnosis. Material and methods: Prospective study of skin biopsies received in our department over a period of 1 year. The biopsies were processed and stained with haematoxylin and eosin and studied under the light microscope. Results: Out of the 26 cases studied, 25 were found to be benign tumours with a single case of keratoacanthoma. The most common tumour encountered was pilomatricoma and the least common was syringoma. Only four cases showed clinical correlation with histopathological diagnosis. Conclusion: It can be therefore concluded that skin adnexal tumours are rare tumours which need histopathological examination for their accurate diagnosis.

Background Keratoacanthoma (KA) is a special kind of tumor, which is regarded as a variant of squamous cell carcinoma (SCC) in some academic disciplines. But differentiating KA from SCC remains a diagnostic challenge. The noninvasive techniques dermoscopy and reflectance confocal microscopy (RCM) can provide new insights for diagnosis. Objective To observe the characteristics of KA under dermoscopy and reflectance confocal microscopy (RCM), in order to gain experience and reference for clinicians to facilitate earlier diagnosis. Methods We collected two cases of KA, which were confirmed by clinical and histopathological examination. The two cases were examined by dermoscopy and RCM, respectively. Then, we collected the microscopic characteristics of KA lesions. Results The dermoscopy features of KA are concentric circles of central crater, keratin mass, keratin scale, and polymorphic vascular pattern. The RCM features are described as refractile crust, atypical honeycomb pattern, dark center cells, large round nucleated cells, dendritic cells, and linear or round vessels traversing dermal papillae in the dermis. Conclusion KA has some specific dermoscopy and RCM features, which can provide a basis for doctors to diagnose and intervene earlier.

Keratoacanthomas (KAs) are distinctive tumors that are defined by their clinical and histopathological features. Their relationship and distinction from squamous cell carcinoma (SCC), however, remain controversial. All cytogenic and immunohistochemical markers that have been applied in this quest have failed. A close relationship of KAs to hair follicles has been recognized. The descriptive term infundibulocystic or infundibular SCC was introduced to define a more broad‐based pathway encompassing KAs. The follicular infundibulum roles in respect to neoplasia and wound healing are important elements in understanding the pathogenesis of KAs. Mouse models for KA have provided insights into the relationship of KA to follicles and SCCs. These advances and together with the diverse clinical and histopathological aspects of KA have contributed to the formulation of a conceptual pathway. The central element is that ultraviolet (UV)‐mutated or activated committed infundibular stem cells are driven by the combination of a mutated oncogenic RAS pathway linked with the Wnt/beta‐catenin pathway responsible for stem cell maintenance, hair follicle development, wound healing and driving KA proliferation and terminal keratinization. The existence and activation of this mutated pathway may form the basis of the paradoxical emergence of KAs and SCCs in patients receiving BRAF and PD‐1 inhibitor therapy.

El queratoacantoma solitario es un tumor queratinocítico localizado en zonas fotoexpuestas que se caracteriza por tener tres fases evolutivas: una primera de crecimiento rápido, una de estabilidad y una final de involución espontánea. Esta última no se observa con tanta frecuencia porque su diagnóstico diferencial, el carcinoma espinocelular, obliga a que la terapia de elección sea la escisión quirúrgica. La decisión de mantener una conducta expectante debe tomarse en conjunto con el paciente, quien debe conocer los riesgos que esta implica. Presentamos los casos de 2 pacientes que rechazaron la opción quirúrgica y tuvieron una evolución favorable con una estricta supervisión clínica.

Muir-Torre syndrome is an autosomal-dominant disorder caused by germline mutations in 1 of the 4 key DNA mismatch repair (MMR) genes, MSH2, MSH6, PMS2, and MLH1. Patients with Muir-Torre syndrome present with skin lesions, which play an important role in early detection of the disease and are considered cutaneous markers. The diagnostic criteria for Muir-Torre syndrome are at least 1 skin neoplasm with sebaceous differentiation, at least 1 visceral malignancy, and germline mutation of the MMR genes.1,2 Sebaceous adenoma is rare and is considered the most significant cutaneous marker for Muir-Torre syndrome.3 Abbas and Mahalingam4 suggested that when a young patient presents with a sebaceous neoplasm outside the head and neck area, immunohistochemical analysis of the MMR genes should be conducted for Muir-Torre syndrome screening. If loss of any MMR proteins is identified, microsatellite instability study or germline analysis is warranted for further diagnosis. In addition, presence of multiple keratoacanthomas should also prompt immunostaining studies for screening.3 In Muir-Torre syndrome, the keratoacanthoma usually presents with sebaceous differentiation.3 For a specific patient, loss of MMR proteins in the skin lesions and in the visceral tumors should be in concordance because of the presence of germline mutation. However, here we examined a visceral tumor and all 16 skin lesions from a patient with Muir-Torre syndrome and found genetic heterogeneity among several samples. All 13 sebaceous adenomas and the visceral tumor showed the same expression pattern of the MMR genes in line with the germline mutation, whereas other skin lesions such as keratoacanthoma and squamous cell carcinoma (SCC) showed aberrant expression patterns. To our knowledge, this is the first study reporting the phenomenon of genetic heterogeneity in a Muir-Torre syndrome patient.

This paper reports a case of xeroderma pigmentosum in a 78-year-old woman with a 17-year history of multiple basal cell carcinomas, keratoacanthoma, and lentigo maligna melanoma, in different photoexposed facial regions. To prevent aggravation of these medical conditions, for five years, the patient had been applying a film-forming topical medical device (MD) containing the DNA-repair enzyme photolyase in liposomes and high-protection UV filters (Repairsomes) twice a day. During this time, the patient had no clinical or dermatoscopic evidence of new skin cancer lesions. However, at her last visit, the patient had a new basal cell carcinoma on the face, in the right supramaxillary area. After questioning, the patient recognized that she had not been applying the product on a regular basis during the last year. This may have been a coincidence; however, there is clinical evidence of the preventive effect of this MD in reducing the cancerization field and consequently the development of skin cancer. This product contains a light-activated flavoenzyme called photolyase which creates the condition to revert cyclobutane pyrimidine dimer. In the discussion of this case, we review recent publications and stress some important aspects on the role of photoprotection and photorepair as a strategy to more effectively reduce the risk of UV-induced premalignant and malignant skin lesions compared to traditional photoprotection strategies.

Introduction: Keratinocyte tumors (KT) are frequently observed. Surgery is the treatment gold standard. In some cases, a surgical approach might not be the best option. Radiotherapy (RT) and systemic treatments can frequently cause side effects or be contraindicated. Intralesional methotrexate (MTX) can be a conservative yet effective alternative. We decided to evaluate the effectiveness and safety of intralesional chemotherapy with MTX for the treatment of squamous cell carcinoma (SCC), keratoacanthoma (KA), and basal cell carcinoma (BCC). Methods: All patients had a histologically confirmed diagnosis of BCC, SCC, or KA and no indication to surgery or RT. MTX was injected subcutaneously proceeding from the periphery of the lesion toward the center. Different protocols in terms of dose, frequency, and length of treatment were used to compare them. Treatment efficacy was evaluated in terms of tumor size reduction. Patients were divided into three groups: responders (improvement of more than 50%), partial responders (< 50%), and non-responders (no improvement or worsening). All data were analyzed using the chi-squared test (χ2). Results: Thirty-five patients were included. Twenty-one patients suffered from SCC, 12 from KA, and 2 from BCC. KA showed a higher response rate than SCC and BCC. For AK, 92% of patients had a complete resolution; 8% were partial responders. For SCC, 47.6% of cases were responders and 14.3% partial responders, while 38% non-responders. All BCCs showed no improvement. A treatment protocol of weekly injections, performed for 4 to 6 weeks, was the most efficient. Doses of 25mg/ml per session seemed to be most effective. About one third of our patients developed side effects with mild anemia being the most frequent. Conclusions: For selected cases, intralesional MTX can be a safe and effective option for the treatment of KT, especially in case of KA and, to a lesser extent, SCC.

Background. Skin cancer is a growing health concern worldwide. It is the most common malignancy in South Africa and places a large burden on the public healthcare sector. There is a paucity of published scientific data on skin cancer in South Africa. Objectives. To report the findings of biopsies performed in patients with suspected skin cancer attending the Tygerberg Academic Hospital (TAH) Dermatology outpatient department (OPD) in the Western Cape Province of South Africa. Methodology: A retrospective chart review identified all patients who underwent a biopsy for a suspected skin cancer diagnosis between September 2015 and August 2016 at the TAH dermatology OPD. Results. A total number of 696 biopsies from 390 participants were identified, of which 460 were histologically confirmed as malignant lesions. The proportion of clinically suspected skin cancers that were histologically confirmed as cancer was 68%. The most commonly occurring malignancies were basal cell carcinoma (BCC) (54.8%), squamous cell carcinoma (SCC) (18.9%), squamous cell carcinoma in-situ (SCCI) (8.0%), Kaposi’s sarcoma (KS) (6.7%), malignant melanoma (MM) (6.1%), and keratoacanthoma (KA) (4.6%). The number needed to treat (NTT) for all cancers diagnosed and for MM was 1.5 and 4 respectively. BCC (89.3%) and KS (67.7%) was the most common skin cancer in the white and black population respectively. The ratio of BCC to SCC was 2.03. Conclusion. This study provides valuable scientific data on the accuracy of skin cancer diagnosis, distribution and patient demographics in the Western Cape Province of South Africa, on which further research can be based. The study highlights the burden of skin cancer on this specific population group and calls for standardised reporting methods and increased surveillance of skin cancers.

Objective: Mutations in genes encoding proteins along the RAS-RAF-MEK-ERK pathway have been detected in a variety of tumor entities, including malignant melanoma, thyroid, colon, over carcinomas and some sarcomas. The increased activity of BRAF V600E leads to downward signalization activation via mitogen-activated protein kinase (MAPK), which plays an important role as cell growth, differentiation and survival regulator. Latest data show BRAF undergoes mutation in nearly 7% of cancers and this situation makes BRAF another important oncogene in this pathway. We aimed to evaluate the relationship between keratacanthoma and BRAF expression.Methods: 28 cases of keratocanthomas were included in this study. Sections were taken from the selected blocks with a thickness of 3 microns with poly-lysine coating. BRAF antibody was applied to the tissues. The obtained preparations were evaluated by light microscopy. It was rated according to the degree of staining in epidermis.Results: Areas showing cytoplasmic staining with BRAF were evaluated in sections. It was observed that there was no staining in the keratocanthomas, and staining in sebaceous glands and sweat glands in peripheral basal cells. It was also noted that the sweat glands had more stain than the sebaceous glands. The cases included 18 males and 10 females with ages varying from 33 to 85 years. The duration of the lesions was between one month and one year. Lesion dimensions varied from 5 to 70 mm, with mean size of 21 mm. There were 14 cases (50%) with head and neck localization, and 14 cases (50%) with localization other than the head and neck.Conclusion: As a result, it has been concluded that BRAF mutation may not be involved in keratoacanthoma.

Pseudocarcinomatous hyperplasia (PCH) is a benign reactive epithelial proliferation that may be associated to lymphomas of the skin or external mucous membranes. We present a case of single lesion mycosis fungoides (Woringer-Kollop's reticulosis pagetoid) associated with PCH that was initially misdiagnosed as squamous cell carcinoma (SCC) and review all PubMed-indexed previously reported cases on lymphomas of the skin or external mucous membranes associated to PCH, SCC, and keratoacanthomas. Including our own case, we collected data of 114 cases of cutaneous or mucosal lymphoproliferative disorders associated to PCH, 3 cases associated to SCC, and other 3 cases associated to keratoacanthomas. All cases were tabulated to the following parameters whenever data was available: sex, age, previous medical conditions, number of lesions (single × multiple), site of involvement (mucosa, skin or both), clinical impression, initial equivocal histopathologic diagnosis, final diagnosis, keratinocytic atypia (presence × absence), lymphocytic atypia (presence × absence), CD30-status, and treatment.

Keratinocyte cancers are the most common malignancy among people with European ancestry, and are very common on sun-exposed areas of the head and neck. Incidence is directly correlated with latitude and annual ultraviolet radiation incidence, although there are a number of other environmental, occupational and genetic risk factors, and keratinocyte cancers become more common at middle age. Basal cell carcinomas (BCC) are the most common, comprising 80% of keratinocyte cancers, but have a very low rate of metastases and low mortality. Squamous cell carcinomas (SCC) make up 20% of keratinocyte cancers, and have relatively infrequent metastases, at 5-16%. While there are no precursor lesions for BCC, SCC represents the final stage in a spectrum of cellular atypia and dysplasia, from actinic keratoses to in situ SCC to invasive SCC. Dermoscopy is a well-established diagnostic tool for keratinocyte cancers, and reflectance confocal microscopy is emerging as another useful diagnostic tool, particularly on functionally and cosmetically sensitive sites like the face.

Neither patient experienced myelosuppression. Acitretin was briefly withheld when the latter patient had hypercholesterolemia until pravastatin was started and cholesterol normalized. Both patients tapered down to acitretin, 10 mg/d after 4 months. After 3 additional months, they tapered to 10 mg every other day for prevention for up to 10 months. At 1-year follow-up, both patients remained without clinical recurrence (Figs 1, D and ​and2,2, D)

Keratoacanthomas (KA) are epithelial tumors that present as rapidly evolving nodules with a central hyperkeratotic plug and occasionally show signs of spontaneous regression. A 21‐year‐old patient strongly refused the diagnostic biopsy and insisted on a nonsurgical treatment. He was successfully treated with imiquimod 5% cream., Surgical excision is the most common treatment option for keratoacanthomas. However, the topical application of the imiquimod 5% cream is a safe and effective option, especially for patients who refuse surgical removal.

A cutaneous horn, sometimes referred to as cornu cutaneum, is a projection arising on the skin due to an overgrowth of the epidermal stratum corneum. This lesion is a clinical presentation of an underlying skin tumor. A woman with a verruca vulgaris-associated cutaneous horn is described. Cutaneous horns are often solitary and appear most commonly on the face, ears, and the dorsum of the hands of older patients. The most frequent tumors associated with cutaneous horns include actinic keratoses and seborrheic keratoses; however, cutaneous horns have also been observed overlying other benign and malignant tumors. In conclusion, a cutaneous horn is a common clinical feature; however, the diagnosis of the underlying skin lesion requires a biopsy that permits adequate microscopic evaluation of the associated tumor.

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.

Debulking followed by intralesional 5-fluorouracil (deb-IL5FU) is a nonsurgical modality which has been used to treat skin cancer anecdotally for many years. There are few in depth studies examining this technique and success rate of intralesional 5-fluorouracil (IL5FU) for the treatment of cutaneous squamous cell carcinoma (cSCC). To evaluate the response rate of deb-IL5FU for the treatment of cSCC and to determine which patient factors were associated with tumor clearance or treatment failure. A retrospective chart analysis of patients with the diagnosis of cSCC or keratoacanthoma (KA) and subsequent deb-IL5FU treatment. Sixty-one patients with a total of 315 tumors (cSCC and KA), were treated using deb-IL5FU. The overall tumor clearance rate was 89%. This was highest for well-differentiated SCC, SCC, KA-type SCC, and KA. Tumors on the trunk and extremities showed high clearance rates while tumors on the scalp/face/neck/ears showed lower clearance rates. Immunocompetent patients cleared more tumors compared to immunocompromised patients. Limitations included the retrospective nature of this analysis as well as a small sample size. Treatment of cSCC and KA with deb-IL5FU demonstrated high tumor clearance rates. Lower rates of clearance were seen in males, immunosuppressed patients, tumors located on the scalp and face/neck/ears.

We present histopathological criteria for diagnosing keratoacanthoma (KA). In KA, four histological stages are recognized, which are the early/proliferative stage, well-developed stage, regressing stage and regressed stage. In diagnosing KA, we emphasize that KA consists of the proliferation of enlarged pale pink cells with ground glass-like cytoplasm without nuclear atypia, other than crateriform architecture. KA sometimes exhibits malignant transformation within the lesions. We describe the characteristics of benign and malignant epithelial crateriform tumors that should be differentiated from KA. We also present the data of histopathological diagnosis of lesions clinically diagnosed as KA, its natural course and related lesions after partial biopsy, and incidence of crateriform epithelial neoplasms. Based on these data, we recommend complete excision of the lesion when KA is clinically suspected, especially when the lesion is located on a sun-exposed area of an elderly patient. If complete excision is impossible, partial excision of a sufficient specimen with intact architecture is required. In such a case, however, careful investigation after biopsy will be needed, even if the histopathological diagnosis is KA, because there is some possibility that a conventional SCC lesion remains in the residual tissue.

Immunocryosurgery is a minimally invasive combinational therapeutic procedure that has been designed, developed, and evaluated in the Dermatology Department of the University of Ioannina from 2004. In a fixed time protocol, this approach combines immune stimulatory therapy with imiquimod and cryosurgery, i.e., cryosurgery is applied during continuous imiquimod treatment. Laboratory findings in tissue and blood level credit the efficacy to the synergy of imiquimod and cryosurgery. The synergy has been established through clinical trials and the excellent feasibility and efficacy demonstrated in clinical practice. Immunocryosurgery has extensive proof of excellent efficacy, comparable to surgery, in the treatment of basal cell carcinoma. It has also been evaluated in cases of Bowen’s disease, keratoacanthoma, Merkel cell carcinoma, lentigo maligna, and cutaneous squamous cell carcinoma with or without the addition of adjuvants. The aims of this review are to detail the immunocryosurgery protocol with the addition of daily practice clinical tips, compile data on the mechanism of action of immunocryosurgery, and delineate indications and possible future applications. Most of the available data originate from the treatment of BCC, of all histological types and localizations, and the principles reported mainly reflect on evidence related to the treatment of this common skin cancer.

is missing (Short communication)

Summary:. An 18-year-old man presented with a fast-growing tumor of the right ala nasi. We excised the tumor and histology report revealed a keratoacanthoma with clear margins. After surgery, the patient was left with a composite defect of 3 × 2 cm. For reconstruction, we used an expanded prelaminated forehead flap with a durable cartilage graft from the ribcage and a turnover flap for inner lining. Our technique had a pleasing end result and excellent patient satisfaction.

Antihypertensive agents such as spironolactone have been reported to cause lichenoid drug eruptions. Eruptive keratoacanthomas (KA), considered to be well-differentiated squamous cell carcinoma (SCC), may develop in the setting of such lichenoid reactions. Thus, definitive treatment is imperative. This case report describes a patient on spironolactone who developed a lichenoid drug eruption followed by eruptive KAs and SCC. The treatment approach used systemic methotrexate. While most treatment regimens for widespread eruptive KA/SCC employ intralesional methotrexate, this case demonstrated the utility of its systemic counterpart. This may have also facilitated the resolution of the patient's lichenoid eruption. There are only three other reports in the literature describing a spironolactone-induced lichenoid drug eruption. Further investigations are needed to evaluate the adverse cutaneous effects of spironolactone as well as the efficacy of systemic methotrexate in treating patients with a significant number of SCCs arising from lichenoid drug eruptions.