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Treatment of Keratoacanthoma: Is intralesional methotrexate an option?
Nima P. Patel, MD
A. Lawrence Cervino MD
Summa Health System / NEOUCOM
2010-03-23
Presenter: Nima P. Patel, MD
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Jonathan Hutchinson first described keratoacanthomas (KA) in 1889 as crater form ulcers on the face. Keratoacanthomas are a variant of squamous cell carcinomas and some have shown aggressive behavior leading to metastasis and death. Surgical excision is the treatment of choice for most KA patients. Intralesional methotrexate may also be a potential treatment option for KA.
Objective: To evaluate intralesional methotrexate as a treatment modality for keratoacanthoma.
Methods: A retrospective chart review of nine patients with keratoacanthoma treated with intralesional methotrexate was performed. Each patient had biopsy proven KA. The lesion was initially debulked and methotrexate was injected at the base. Patients were
seen weekly in the office and reinjected with intralesional methotrexate depending on the response. Each patient was evaluated for the response to intralesional methotrexate
injections, number of injections required and complications.
Results: Patients required anywhere from two to four injections (12.5mg-25mg per injection) prior to the resolution of the KA. Eight out of nine (88.9%) had complete resolution of the tumor. One patient had failure of treatment and underwent surgical excision of the KA. Our average follow-up was 2.8 years and there were no recurrences.
Conclusion: Our results from this retrospective study show intralesional methotrexate injection is an effective treatment option for keratoacanthoma. We propose that intralesional methotrexate injection with initial debulking of the KA should be used as a first line of treatment when KAs are present on the extremities, cosmetic sensitive areas as well as in elderly patients with multiple comorbities.
