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Intralesional Injection of Methotrexate for Treatment of Keratoacanthoma
Shoichiro A. Tanaka, MD
A. Lawrence Cervino, MD
Summa Health System
2020-02-15
Presenter: Shoichiro A. Tanaka, MD
Affidavit:
I certify that this project represents the original work of the fellow.
Director Name: Douglas Wagner, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Keratoacanthoma (KA) is a known variant of squamous cell carcinoma (SCC). While most instances of KA demonstrate spontaneous involution, some have shown aggressive behavior, leading to metastasis and death. Surgical excision is the treatment of choice for most KA patients. Our hypothesis is that intralesional methotrexate (MTX) injection may be a treatment option for KA.
Methods:
This is an IRB-approved retrospective chart review of all patients with biopsy proven KA treated with intralesional MTX injection by the senior author between 2014 – 2018. The lesion was initially debulked with shave excision and curettage of the base, followed by injection of MTX (25 mg/mL) at the base. Patients underwent weekly serial injections of MTX. Each patient was evaluated for treatment response, the number and dose of injections required, and complications.
Results:
A total of 18 patients were treated in that time frame. Average age was 75.2 years, and 55% were male. Five lesions were located in the upper extremity, 6 lesions in the lower extremity, and 7 lesions on the face. Average size was 1.7 cm (1-3.5 cm). The majority of patients received 3 doses, ranging from 0.5– 1.0 mL. Sixteen patients (88.9%) had resolution of KA, with 2 patients experiencing treatment failure, 1 of which underwent surgical excision. There were no complications with treatment.
Conclusion:
Intralesional injection of MTX is a safe and effective treatment option for KA. This treatment modality should be used as first-line therapy for KA in difficult anatomic locations as well as patients with multiple comorbidities.
