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CASE REPORT
Year : 1990  |  Volume : 56  |  Issue : 5  |  Page : 393-395

Multinodular keratoacanthoma




Correspondence Address:
Vijay Kumar Keratinodular


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  Abstract 

Clinical features of Multinodular Keratoacanthoma in two patients are reported. One patient was having squamous cell carcinoma of de novo origin with secondaries in lymph nodes in addition to multinodular keratoacanthoma.


Keywords: Multinodular keratoacanthoma, Squamous cell carcinoma


How to cite this article:
Keratinodular VK, Garg B R, Baruah M C, Ratnakar C. Multinodular keratoacanthoma. Indian J Dermatol Venereol Leprol 1990;56:393-5

How to cite this URL:
Keratinodular VK, Garg B R, Baruah M C, Ratnakar C. Multinodular keratoacanthoma. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Sep 19];56:393-5. Available from: http://www.ijdvl.com/text.asp?1990/56/5/393/3584


Recently Eliezri et al[1] described 'Multinodular Keratoacanthoma', a morphologically recognised variant or keratoacanthoma, and reviewed the literature. According to them, multinodular keratoacanthoma is characterised by multiple keratoacanthoma nodules at the periphery of a progressively expanding tumour showing central scarring and no tendency toward spontaneous resolution. We report two more cases of multinodular keratoacanthoma for its rarity.


  Case reports Top


Case 1 : A 59 year old man came with the complaints of round firm swellings over right leg of 3 years duration. It started with asymptomatic multiple nodular lesions over the lateral aspect of right leg above ankle. General physical and systemic examinations were within normal limits. Dermatological examination revealed multiple globular nodules of 1.5 to 2 cm diameter around central scarring with an overlying crater filled with keratin [Figure - 1]. The nodules were firm, non-tender and freely mobile. The skin proximal to the lesions had depigmentation and hyperpigmentation. A clinical diagnosis of nodular keratoacanthoma was made and confirmed histopathologically [Figure - 2].

All the pertinent investigations were normal. Tuberculin test was negative. A split skin graft was given after excision of the whole lesion. The patient was followed for 2 years and there was no recurrence.

Case 2 : A 58 year old man presented with a swelling of left leg for 2 years and ulcer over right leg of 2 months duration. He developed a nodule in front of his left leg preceded by itching. The nodule progressively increased in size. On the right leg he had depigmented itchy patch which ulcerated within 2 months. A painful swelling with discharging sinus appeared in the right groin a month ago. General physical and systemic examinations were within normal limits. Cutaneous examination showed a hypertrophic, verrucous plaque of 5 x 4 cm size on middle third of the left leg with intervening depigmentation, hyperpigmentation and atrophy. Depigmented macules were present around the plaque [Figure - 3]. The plaque was freely mobile and non­tender. On the lateral aspect of the right leg, there was a well demarcated ulcer with elevated margins, floor covered with serosanguinous discharge, 3 x 4 cm in size, fixed to underlying structures, non-tender and bled on manipulation. The inguinal glands on the same side were enlarged, matted, firm to hard and fixed to the underlying structures. Three discharging sinuses were present over the swellings which were not interconnected on probing. No other groups of lymphnodes were enlarged. A clinical diagnosis of keratoacanthoma on the left leg and squamous cell carcinoma with secondaries of inguinal lymphnodes on the right leg was made. Biopsy from both the lesions confirmed our clinical diagnosis. The patient refused any surgery and finally lost to follow up.


  Comments Top
:

Eliezri and Libow[1] while describing their two cases in addition to seven cases from literature preferred the term `multinodular keratoacanthoma' because of the multinodularity of the lesions. These types of lesions have been described commonly as keratoacanthoma centrifugum marginatum[2],[3] Kopf[4] used the term multinodular keratoacanthoma for similar lesions.

In our patients-also similar morphological and histological features as described by Eliezri and Libow were observed. There was no self resolution of the lesion. First patient was successfully treated with excision and a split skin graft.

The interesting features in our second patient are squamous cell carcinoma de novo with secondaries in the inguinal lymphnodes on the same side in addition to multinodular keratoacanthoma.

The points in favour of de novo squamous cell carcinoma are negative history and no clinical evidence of keratoacanthoma around the ulcer.

 
  References Top

1.Eliezri YD and Libow L: Multinodular keratoacanthoma. J Amer Acad Dermatol, 1988; 19: 826-830.  Back to cited text no. 1    
2.Heid E, Grosshans E, Lazrak B and Ben Yahia D: Keratoacanthoma centrifugum marginatum. Ann Dermatol Venereol, 1979; 106: 367-370.  Back to cited text no. 2    
3.Weedon D and Barnett L: Keratoacanthoma centrifugum marginatum. Arch Dermatol, 1975; 111: 1024-1026.  Back to cited text no. 3    
4.Kopf AW: Keratoacanthoma, in: Cancer of the Skin, WB Saunders, Philadelphia, 1976; 763-764.  Back to cited text no. 4    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Multinodular keratoacanthoma: A rare but definite entity
Sardana, K., Sarkar, R., Garg, V.K., Koranne, R.V., Sharma, R.C., Sethi, S.
International Journal of Dermatology. 2002; 41(12): 905-907
[Pubmed]



 

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