?KA is benign despite its similarities to squamous cell carcinoma (SCC), or the abnormal growth of cancerous cells on the skin’s most outer layer”
Dear Cancer Coach:
I had a growth on my leg that was determined to be keratoacanthoma. A dermatologist cut it out and sent it to pathology. I haven’t received the pathology report myself yet.
The dermatologist wants me to get a shot of 5FU instead of Mohs surgery. His comment was he didn’t want it to bite me 10 years down the road. I’m 75 and not sure I’ll be alive 10 years from now.
If it isn’t SCC (non-melanoma skin cancer), should I have the 5FU or should I leave it alone? If it is SCC, then what?
Thanks for a reply. Sue
Hi Sue-
Let me ask you a few questions before we settle on your next steps.
1) When you say that your dermatologist “cut it out” are you saying that he/she removed the entire KC? If so the pathologist should be able to make a complete report. A report that you should be able to use to make better decisions.
2) Ask you can read from the bold face below, your decision-making may be influenced by a) KC or SCC b) specific diagnosis based on “the entire structure”
“Under the microscope, keratoacanthoma very closely resembles squamous cell carcinoma. In order to differentiate between the two, almost the entire structure needs to be removed and examined. While some pathologists classify KA as a distinct entity and not a malignancy, about 6% of clinical and histological keratoacanthomas do progress to invasive and aggressive squamous cell cancers; some pathologists may label KA as “well-differentiated squamous cell carcinoma, keratoacanthoma variant”, and prompt definitive surgery may be recommended.[3][4][5][6]”
Finally, your instincts are accurate. 5-FU is chemotherapy and chemotherapy can mean collateral damage. It is difficult for any 75 year old to worry too much about the 10 year picture. Especially when considering quality-of-life issues.
How do you feel about emailing me again once you receive the pathologist’s report?
thanks
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
“Keratoacanthoma (KA) is a common low-grade (unlikely to metastasize or invade) rapidly-growing skin tumour that is believed to originate from the hair follicle (pilosebaceous unit) and can resemble squamous cell carcinoma.[1][2]
The defining characteristic of a keratoacanthoma is that it is dome-shaped, symmetrical, surrounded by a smooth wall of inflamed skin, and capped with keratin scales and debris. It grows rapidly, reaching a large size within days or weeks, and if untreated for months will almost always starve itself of nourishment, necrose (die), slough, and heal with scarring. Keratoacanthoma is commonly found on sun-exposed skin, often face, forearms and hands.[2][3] It is rarely found at a mucocutaneous junction or on mucous membranes.[2]
Keratoacanthoma may be difficult to distinguish visually from a skin cancer.[4] Under the microscope, keratoacanthoma very closely resembles squamous cell carcinoma. In order to differentiate between the two, almost the entire structure needs to be removed and examined. While some pathologists classify keratoacanthoma as a distinct entity and not a malignancy, about 6% of clinical and histological keratoacanthomas do progress to invasive and aggressive squamous cell cancers; some pathologists may label KA as “well-differentiated squamous cell carcinoma, keratoacanthoma variant”, and prompt definitive surgery may be recommended.[5][6][7][8]
Diagnosis[edit]
If the entire lesion is removed, the pathologist will probably be able to differentiate between keratoacanthoma and squamous cell carcinoma. Follow-up would be required to monitor for recurrence of disease.[15]
Treatment[edit]
Excision of the entire lesion, with adequate margin, will remove the lesion, allow full tissue diagnosis, and leave a planned surgical wound which can usually be repaired with a good cosmetic result…
On the trunk, arms, and legs, electrodesiccation and curettage often suffice to control keratoacanthomas until they regress. Other modalities of treatment include cryosurgery and radiotherapy; intralesional injection of methotrexate or 5-fluorouracil have also been used.[14]
Recurrence after electrodesiccation and curettage can occur; it can usually be identified and treated promptly with either further curettage or surgical excision.[6]..
Keratoacanthoma
What is keratoacanthoma?
Keratoacanthoma (KA) is a low-grade, or slow-growing, skin cancer tumor that looks like a tiny dome or crater. KA is benign despite its similarities to squamous cell carcinoma (SCC), or the abnormal growth of cancerous cells on the skin’s most outer layer. KA originates in the skin’s hair follicles and rarely spreads to other cells…
How is keratoacanthoma treated?
KA will go away on its own, but this can take many months. Your doctor may recommend surgery or medication to remove KA.
Removal treatments
Treatment options depend on the location of the lesion, the patient’s health history, and the size of the lesion. The most common treatment is a minor surgery, under a local anesthetic, to remove the tumor. This may require stitches, depending on the size of the KA.
Other treatments include:
- If you have cryosurgery, your doctor will freeze the lesion with liquid nitrogen to destroy it.
- If you have electrodesiccation and curettage, your doctor will scrap or burn off the growth.
- If you have Mohs’ microscopic surgery, your doctor will continue to take tiny pieces of skin until the lesion is completely removed. This treatment is most often used on the ears, nose, hands, and lips.
- Doctors use radiation treatment and X-ray therapy for people who are unable to have a surgical procedure for other health reasons…”
