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Year : 1996  |  Volume : 62  |  Issue : 3  |  Page : 195-196

Keratoacanthoma masquerading as squamous cell carcinoma

SGS Krishnan, Devakar P Yesudian, M Jayaraman, Ja 

Correspondence Address:
SGS Krishnan

How to cite this article:
Krishnan S, Yesudian DP, Jayaraman M, Ja. Keratoacanthoma masquerading as squamous cell carcinoma.Indian J Dermatol Venereol Leprol 1996;62:195-196

How to cite this URL:
Krishnan S, Yesudian DP, Jayaraman M, Ja. Keratoacanthoma masquerading as squamous cell carcinoma. Indian J Dermatol Venereol Leprol [serial online] 1996 [cited 2020 Jan 25 ];62:195-196
Available from: http://www.ijdvl.com/text.asp?1996/62/3/195/4377

Full Text

 To the Editor,

Keratocanthoma is a rapidly evolving tumour of the skin composed of keratinising squamous cells originating from pilosebaceous follicles. It can closely simulate squamous cell carcinoma both clinically and histologically.[1] While solitary keratoacanthoms are not uncommon, the multiple variety is rare.[2]

A 55-year-old male tailor presented with complaints of recurrent horny lesions over both lower limbs of 30 years duration. Lesions initially grew rapidly for 1-2 months and then stopped growing. Some of the lesions resolved spontaneously, while surgical excision of the remaining lesions was done in 1965. The lesion recurred again over the angle of the mouth on the right side. It was excised and reported as squamous cell carcinoma. For the past 6 months he had a fungating mass, 13x10 cm, over left foot extending from ankle posteriorly to the middle of the foot exteriorly [Figure:1]. A horny lesion was seen adjacent to this. Multiple horny lesions were present over both limbs with involvement of nail fold sulci. 5-6 inguinal lymph nodes were palpable, which were discrete, firm, mobile and non-tender.

Systemic examination was non contributory. Indirect laryngoscopy, ultrasonogram of abdomen and upper GI endoscopy did not reveal any abnormality. Multiple biopsies from the edges of the lesion showed an irregular large central crater filled with keratin material. Epidermis extended on either side as a lip. There were no bizzare mitotic figures or hyperchromatic nuclei to suggest squamous cell carcinoma. A diagnosis of keratoacanthoma was made. Histopathology of the inguinal lymph nodes did not show any metastasis. Total excision of fungating mass was done with split skin grafting. Rest of the lesions were untouched. Two of patient's sibling also had similar lesions while rest of the family members were normal.

Points which may help on histological differentiation between early keratoacanthoma and squamous cell carcinoma include the following.[3] In keratoacanthoma, organisation of epithelial growth is not disturbed and cells are attached to one another with well formed prickles. Mitotic figures when present are of natural appearance and the ratio of nucleus to nucleoli is unaltered. Basal cell membrane is sharply limited and well preserved and dermal inflammatory infiltrate permeates the epithelial growth. These are not seen in squamous cell carcinoma. Inspite of these differences it may be difficult to differentiate the two conditions as had happened in our case.


1Mackie RM. Epidermal skin tumours. In : Champion RH, Burton JL, Ebling FJG, editors. Textbook of dermatology. Oxford : Blackwell, 1992:1470.
2Baer RL, Kopf AW. Keratoacanthoma. In : Year book of dermatology. Chicago : Year Book Medical Publishers, 1962:7-14.
3De Moragas JM, Montgomerry H, McDonald JR. Keratoacanthoma versus squamous cell carcinoam. Arch Dermatol 1957;77:390-5.


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