Keratoacanthomas are rapidly growing epidermal tumours which develop central necrosis and ulceration. They occur on sun-exposed skin in later life and can grow up to 2-3 cm across. Whilst they may resolve spontaneously over a few months, they are best excised both to exclude a squamous cell carcinoma (which they can mimic) and to improve the cosmetic outcome.
Keratoacanthomas is a pseudo-carcinomatous hyperplasia, sort of transition between benign keratosis and definite epithelioma. Its incidence is low in India . It consists usually of a solitary lesion; multiplex and generalized varieties have been described.
Typical keratoacanthoma is seen on the face or dorsum of hands, as a rapidly growing (1-2 cm in 1-2 months), firm, hemispherical nodule with a central crater covered by a keratinous crust. There is spontaneous resolution within a couple of months leaving a puckered scar.
It signifies diffuse plaques of hyperplasia of the stratum corneum of the skin, particularly of the ahnds and feet, eg.,tylosis, congenital, arsenical, menopausal, chronic eczema, syphilis, psoriasis, avitaminosis, pityriasis rubra pilaris, etc.
Histopathology is characteristic. It consists of a crater filled with keratinous material, epithelial hyperplasia with marked keratinization (keratinous pearls) and dense inflammatory infiltrate.
Treatment is surgical excision or electro-cauterization. Though the disorder is self-healing, treatment is recommended in order to be safe and to get good cosmetic results.
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