1/218. Solitary keratoacanthoma of the nipple in a male. Case report. A heretofore undescribed localization for solitary keratoacanthoma, namely the skin of the nipple, is reported. The tumor developed in a 69-year-old man who had suffered a trauma in the thorax near the left nipple 5 months before. A possible origin in mammary ducts, considering the breast as a modified sweat gland, is discussed. ( info) |
2/218. CO 2 laser surgery in hemophilia treatment. The use of CO 2 laser surgery between 1985 and 1991 in south africa and portugal for treatment of disorders in patients with mild to moderate cases of hemophilia A is discussed. Six cases of oral procedures and excision of skin tumors performed during this period are reported. In most of the cases of mild hemophilia no pre- or postoperative infusion of factor viii or desmopressin (DDAVP) was required. In some cases of moderate hemophilia, patients were infused with desmopressin (0.3 mug/kg body weight) and were treated postoperatively with the use of nasal desmopressin spray (150 mug to each nostril for four weeks following surgery). factor viii levels were measured before surgery. Follow up of four weeks was uneventful. The mean average power of the CO 2 laser was 20 W continuous and the pulse duration was 0.1 s for ablational procedures. For dermatologic procedures, a flexible plastic CO 2 laser hollow fiber was used (Flexilase, Sharplan, Allandale, NJ). We concluded that CO 2 laser surgery for hemophiliacs has a confirmed place in modern laser technology provided the standard precautions are taken and facilities are available. ( info) |
3/218. Squamous cell carcinoma and keratoacanthoma of the lower lip associated with "Goza" and "Shisha" smoking. BACKGROUND: A positive correlation between lip and buccal cancers and pipe smoking has been suggested. Various types of crude and manufactured tobacco products are consumed by smoking, chewing, and snuff dipping habits. 'Shisha" and 'Goza' smoking are widely practiced in the middle east. The 'hubble-bubble' method and apparatus are used. These smoking habits are hazardous to health, causing obstructive lung disease, and may be important predisposing factors for the development of oral cancers. case reports: Two cases of squamous cell carcinoma and a case of keratoacanthoma localized to the lower lip are presented in well-known 'Shisha' and 'Goza" smokers. CONCLUSIONS: "Shisha" and 'Goza' smoking have adverse effects on general health and may predispose to oral cancer. An extensive epidemiological study should be performed to determine whether this type of smoking habit is associated with a statistically increased incidence of squamous cell carcinoma and keratoacanthoma of the lips. ( info) |
4/218. Synchronous appearance of keratoacanthomas in burn scar and skin graft donor site shortly after injury. skin malignancies can originate in burn scars (Marjolin's ulcer). The most common is squamous cell carcinoma, usually appearing years after injury. Split-thickness skin graft donor sites as a source of malignant transformation are far less frequent and demonstrate a shorter interval between surgery and tumor onset. Keratoacanthomas have rarely been reported to arise in such scars. We describe the simultaneous occurrence of keratoacanthomas on a spontaneously healed second-degree burn on the flank and in the scar of a skin graft donor site on the thigh, 4 months after a 40% total body surface area burn. ( info) |
5/218. A case of soft tissue mesenchymal chondrosarcoma metastatic to skin, clinically mimicking keratoacanthoma. We report the first case of metastatic involvement of the skin by a soft tissue mesenchymal chondrosarcoma (MS). A 64-year-old man presented 15 months after resection of a 7.0 cm MS from his left forearm with a rapidly growing, erythematous nodule on the left side of the upper lip. The lesion was clinically interpreted as a keratoacanthoma. The histologic appearance was identical to that of the soft tissue MS; an immunohistochemical stain for CD99 was positive. lung and bone metastases were subsequently documented. Our case expands the differential diagnosis of malignancies with cartilaginous differentiation that can involve the skin. ( info) |
6/218. Multiple familial keratoacanthoma of Witten and Zak - A report of three siblings. Three out of 11 siblings of a nonconsanguineous marriage suffering from biopsy-proven multiple small eruptive keratoacanthoma (KA) of Grzybowski as well as large nodular KA of Ferguson-Smith are reported. The response to oral methotrexate was not encouraging. Intravenous 5-fluorouracil (5-FU) at a dose of 12 mg/kg/day in isotonic saline given in weekly 5-day cycles resulted in almost complete resolution of small eruptive lesions and signs of involution in older large agglomerate noduloulcerative KA after 6 cycles. Thus, intravenous 5-FU was found to be an effective therapeutic modality for the Witten and Zak type of KA. ( info) |
7/218. keratoacanthoma centrifugum marginatum arising from a scar after skin injury. Among the variants of solitary keratoacanthoma, keratoacanthoma centrifugum marginatum (KCM) is characterized by the lack of a tendency toward spontaneous remission and by continuous centrifugal spread. We describe a case of KCM arising from the scar after an old skin injury. The lesion appeared on the dorsum of the right hand, grew peripherally for 30 months, and became a tumor with a multinodular margin and central atrophy. A biopsy specimen from the edge of the tumor showed features resembling typical solitary keratoacanthoma. ( info) |
8/218. Eruptive keratoacanthomas following carbon dioxide laser resurfacing. BACKGROUND: skin resurfacing with the carbon dioxide (CO2) laser is currently a popular means of improving rhytides and scars. Scarring, hyperpigmentation, hypopigmentation, and infection are among the complications that have been known to occur in some patients treated with the CO2 laser. OBJECTIVE: We wish to communicate a previously unreported complication of CO2 laser resurfacing-multiple eruptive keratoacanthomas. METHOD: We describe a 61-year-old woman who presented with multiple eruptive keratoacanthomas subsequent to CO2 laser resurfacing. Her lesions were cultured for fungus and bacteria. biopsy specimens of two lesions were taken. RESULTS: Cultures were negative for pathogens. biopsy specimens revealed atypical squamous epithelial proliferation and changes consistent with eruptive keratoacanthomas. CONCLUSION: Multiple eruptive keratoacanthomas should be considered as a rare complication of CO2 laser resurfacing. ( info) |
9/218. muir-torre syndrome: case report of a patient with concurrent jejunal and ureteral cancer and a review of the literature. BACKGROUND: muir-torre syndrome is a rare autosomal dominant genodermatosis, first described in 1967, characterized by the presence of sebaceous tumors and an internal malignancy in the absence of other predisposing factors. OBJECTIVE: Our purpose was to review and update published literature on muir-torre syndrome. methods: We describe a 66-year-old white man with a history of sebaceous tumors and newly diagnosed transitional cell cancer of the right ureter and adenocarcinoma of the jejunum. The literature on muir-torre syndrome is reviewed by means of medline search and available published reports and updated. RESULTS: Only 205 cases of muir-torre syndrome with 399 internal malignancies have been reported. The common presentation is the presence of sebaceous tumors along with a low-grade visceral malignancy. Sebaceous tumors appeared before the internal malignancy in 45 cases (22%), concurrently in 12 (6%), and after the internal malignancy in 114 (56%). In 33 (16%) of 205 patients, a temporal relationship was not reported. The total number of sebaceous gland carcinomas reported is 44; 17 of 44 were neoplasms of the meibomian gland. Keratoacanthomas have been noted in 48 (23%) of 205 patients. Gastrointestinal cancers are the most common internal malignancies (61%), followed by genitourinary (22%). CONCLUSION: The presence of sebaceous tumors warrants a search for an internal malignancy. In patients with muir-torre syndrome, regular follow-up and search for new malignancy is mandatory. Evaluation and monitoring of the family members of patients are also necessary. patients and their families should be counseled for genetic testing. Genetic analysis of the primary tumor and skin lesions should be arranged as an added research tool if possible to better understand the disease. ( info) |
| keratoacanthoma is a common, benign cutaneous neoplasm that displays rapid growth on sun-exposed skin. Keratoacanthomas usually involute spontaneously after several months but rarely progress to squamous cell carcinoma. Because this is a benign, self-limited lesion of exposed skin, effective treatment should emphasize patient comfort and cosmetic results in addition to effectiveness. The authors present 2 patients with keratoacanthomas treated with topical 5-fluorouracil. Both patients had complete resolution of their lesions within 8 weeks. The cosmetic result was superb in both patients. patient satisfaction with this therapy was excellent. Treatment can be instituted based on a clinical diagnosis; no diagnostic biopsy is necessary. Most keratoacanthomas respond to topical 5-fluorouracil therapy within 3 weeks, whereas squamous cell carcinomas respond poorly. Any lesion that shows a poor response after 3 weeks of therapy or that does not resolve within 8 weeks should undergo prompt excisional biopsy for definitive diagnosis and treatment. Topical 5-fluorouracil is an effective, convenient, relatively inexpensive treatment for keratoacanthoma that produces excellent cosmetic results. It should be added to the therapeutic armamentarium of all physicians who treat keratoacanthoma. ( info) |