isotretinoin and Keratoacanthoma

A 27-year-old white woman was referred for consultation with regard to the presence of extensive multiple keratotic lesions. She began to develop these lesions at the age of 9 years, with healing of the lesions resulting in scar formation. A biopsy was performed at the age of 16 years, but the patient was unsure of the results. Since then, she had not had any treatment or biopsies, and stated that she had not suffered from any health problems during the intervening period. She was most concerned about the tumors on her heels and soles, which caused difficulty with ambulation. The family history was negative for skin diseases, including melanoma, nonmelanoma skin cancer, psoriasis, and eczema, and positive for Type II diabetes mellitus. A relative reported that the patient's grandfather had similar lesions, but the patient's parents and siblings were healthy. She was married and had one child, a 9-year-old daughter. Her child had no skin lesions. The patient's only medication was Ortho-Tricyclene birth control pills. She had no known drug allergies. Physical examination revealed the presence of multiple lesions on her body (Fig. 1). Her left superior helix contained a well-demarcated, dome-shaped nodule with a rolled, mildly erythematous border with a central hyperkeratotic plug. A similar lesion was present in the scaphoid fossa of the left ear and smaller lesions were scattered on her face. Numerous lesions were present on the arms and legs bilaterally, with the majority of lesions being located on the anterior lower legs. There were also lesions present on the palms and soles. The lesions ranged in size from 5 mm to 3 cm, the largest being a verrucous exophytic nodule on the anterior aspect of her left leg. Overall, there appeared to be two distinct types of lesion. One type appeared round, oval, and symmetric with a central keratotic plug, similar to that on the ear. The other type was larger, more exophytic, and verrucous, including the lesions on the volar surfaces. Also present were numerous, irregularly shaped atrophic scars where previous lesions had healed spontaneously. There were no oral lesions or lesions on her fingernails or toenails, and her teeth and hair were normal. A biopsy was obtained from an early lesion on the right dorsal forearm. Histology revealed an exo-/endophytic growth having a central crater containing keratinous material (Fig. 2). The crater was surrounded by markedly hyperplastic squamous epithelium with large squamous epi

Topics: Acitretin; Adult; Biopsy; Female; Humans; Isotretinoin; Keratoacanthoma; Keratolytic Agents; Nicotinic Acids

A keratoacanthoma centrifugum marginatum (KACM) may pose a diagnostic and therapeutic challenge. Clinically and histologically, it may resemble mycobacterial or deep fungal infection or halogenoderma. Therapy can be challenging because the lesion can expand to a great size. We report on a patient with multiple lesions of KACM. The diagnostic difficulty and the therapeutic failure of imiquimod, intralesional methotrexate (MTX), and isotretinoin, as well as the therapeutic success of 5-fluorouracil (5-FU) cream, are discussed.

Topics: Aged; Dermatologic Agents; Fluorouracil; Humans; Immunosuppressive Agents; Isotretinoin; Keratoacanthoma; Leg Dermatoses; Male; Treatment Failure

We report on a 63-year-old female patient with Muir-Torre syndrome (MTS). In the course of this disease two carcinomas of the colon, a kerato-acanthoma and multiple sebaceous gland tumours, including four sebaceous carcinomas, appeared. This case is thought to be a hereditary form as one of daughters was also found to have a sebaceous epithelioma. MTS is a mostly autosomal-dominant disease with the association of sebaceous gland tumours and internal carcinomas. As the malignant tumours only show slight aggressiveness the prognosis is quite favourable. Oral isotretinoin therapy was successfully used for the inhibition of sebaceous gland proliferation. A narrower definition is presented and an updated survey of the published cases is given. Furthermore, the histopathologic peculiarities of sebaceous gland tumours, especially of sebaceous gland carcinomas, are discussed and compared to sebaceous gland tumours not connected with MTS. A total number of 100 of the 135 published cases of MTS were included and analysed regarding sebaceous gland tumours and other skin tumours. The data on internal carcinomas were taken from the work of Cohen et al. (1991) and 11 current cases were added.

Topics: Adenocarcinoma; Adenoma, Sweat Gland; Adenomatous Polyposis Coli; Administration, Oral; Carcinoma; Carcinoma, Squamous Cell; Chromosome Aberrations; Chromosome Disorders; Diagnosis, Differential; Facial Neoplasms; Female; Genes, Dominant; Humans; Isotretinoin; Keratoacanthoma; Middle Aged; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Neoplastic Syndromes, Hereditary; Sebaceous Gland Neoplasms; Sweat Glands; Syndrome

Generalized eruptive keratoacanthomas of Grzybowski is a rare condition of unknown etiology. The disease is characterized by the abrupt onset of many small crateriform papules on the skin and mucous membranes. The authors report of a man with multiple eruptive keratoacanthomas of Grzybowski who responded favorably to oral isotretinoin therapy. After 2 years of follow-up, a complete regression of all lesions was observed, and this rapid clearance under isotretinoin therapy is intriguing with regard to the possible etiology of the condition.

Topics: Humans; Isotretinoin; Keratinocytes; Keratoacanthoma; Keratolytic Agents; Male; Middle Aged; Skin

Topics: Aged; Extremities; Female; Humans; Isotretinoin; Keratoacanthoma; Keratolytic Agents; Skin Diseases

Keratoacanthoma is a common cutaneous neoplasm, although the persistent form is less common and often more difficult to manage. Multiple treatment approaches have been attempted with variable efficacy. Establishing the diagnosis and selecting a treatment plan for persistent keratoacanthoma is often challenging.. Our purpose is to describe the difficulty one may encounter in the diagnosis and treatment of persistent keratoacanthoma. Hopefully, review of this clinical conundrum may facilitate the management of the reader's future patients.. We describe a case of persistent keratoacanthoma where the diagnosis was initially elusive and the management challenging. Our thought process during each stage of diagnosis and management is described in the form of "issues" with references to the appropriate literature.. After several diagnostic and therapeutic interventions, successful treatment was achieved with administration of oral isotretinoin. Long-term remission continued as the dosage was tapered.. Persistent keratoacanthoma may be challenging to diagnose and manage, presenting a clinical conundrum. Careful review of the clinicopathologic presentation and an understanding of the various treatment options may result in a successful outcome.

Topics: Administration, Oral; Chemotherapy, Adjuvant; Combined Modality Therapy; Dermatologic Surgical Procedures; Humans; Isotretinoin; Keratoacanthoma; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Skin; Skin Neoplasms; Treatment Outcome

A 78-year-old man is described, who over 18 years developed three different types of keratoacanthoma: multiple keratoacanthomas, keratoacanthoma centrifugum marginatum and giant keratoacanthoma. Histological examination of the different neoplasms showed similar changes, all typical of a keratoacanthoma. In situ hybridisation revealed no human papilloma virus in the tumours. Complete examination showed no associated internal malignancy. After repeated surgical treatment oral isotretinoin treatment was administered (1 mg/kg per day). This treatment produced clearing of existing keratoacanthomas and, during a period of 2 months, further keratoacanthoma formation was completely suppressed. Treatment was stopped after 3 months by the patient because of side-effects. Numerous keratoacanthomas developed during the following 6 weeks.

Topics: Administration, Oral; Follow-Up Studies; Hand; Humans; Isotretinoin; Keratoacanthoma; Keratolytic Agents; Lip; Male; Middle Aged; Thorax

Keratoacanthoma is a benign epithelial tumor that occurs on the sun-exposed skin of elderly people. Development of KAS on functionally and cosmetically important areas such as the face poses the therapeutic challenge to minimize functional and cosmetic damage. Oral isotretinoin (Accutane, Roche Laboratories) has been reported to be an effective treatment of multiple as well as solitary keratoacanthomas.. A 45-year-old man with a large keratoacanthoma on the nasal ala, recurrent after surgical excision, was treated with 1 mg/kg/day (80 mg/day) oral isotretinoin (Accutane). Cessation of tumor progression was evident within 1 week after initiation of therapy, and tumor regression was evident within 2 weeks. Tumor size diminished rapidly over the ensuing weeks and complete resolution at 12 weeks was confirmed by biopsy.. An initial trial of oral isotretinoin is an alternative to immediate surgical excision for the treatment of large keratoacanthomas in instances when tumor removal would cause considerable cosmetic deformity.

Topics: Administration, Oral; Biopsy; Combined Modality Therapy; Humans; Isotretinoin; Keratoacanthoma; Male; Middle Aged; Nose Diseases; Recurrence; Remission Induction

Multiple keratoacanthomas developed on the face of a woman after radiation therapy to the nasal sinuses. Treatment with isotretinoin appeared to shorten her recovery period.

Topics: Facial Dermatoses; Female; Humans; Isotretinoin; Keratoacanthoma; Middle Aged; Paranasal Sinus Neoplasms; Radiotherapy, High-Energy

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Facial Dermatoses; Female; Humans; Isotretinoin; Keratoacanthoma; Male; Middle Aged; Recurrence; Skin Diseases

Topics: Fluorouracil; Humans; Isotretinoin; Keratoacanthoma; Podophyllin; Tretinoin

A patient with multiple keratoacanthomas was successfully treated with oral isotretinoin. The treatment resulted in clearing of existing keratoacanthomas and prevented the development of new lesions. An induction dose of 1.5 mg/kg/day was necessary to initiate the response. This is the third report of successful treatment of multiple keratoacanthomas with isotretinoin.

Topics: Administration, Oral; Adult; Humans; Isotretinoin; Keratoacanthoma; Male; Skin; Skin Diseases; Tretinoin

Two representative cases of familial Muir-Torre syndrome are presented. Multiple benign sebaceous neoplasms in both cases and a solitary keratoacanthoma in one were successfully treated with oral isotretinoin. Low-dose maintenance therapy has stabilized the cutaneous manifestations in the two patients, and no new epithelial neoplasms have appeared. This report emphasizes (1) the rationale for the use of isotretinoin in the Muir-Torre syndrome and (2) the potential for a familial pattern of inheritance and a possible association with the cancer family syndrome. It speculates on the prevention of future internal malignancies in Muir-Torre syndrome patients by maintenance oral isotretinoin treatment.

Topics: Administration, Oral; Female; Humans; Isotretinoin; Keratoacanthoma; Middle Aged; Neoplasms, Multiple Primary; Sebaceous Gland Neoplasms; Syndrome; Tretinoin

An 83-year-old woman with multiple squamous cell carcinomas and keratoacanthomas of the legs was treated with orally administered isotretinoin (13 cis-retinoic acid). Complete regression of the tumors was noted during the initial six-month treatment period. In the subsequent 36 months, four new cutaneous tumors were excised. There have been no recurrences of lesions that regressed while the patient was receiving retinoid therapy.

Topics: Administration, Oral; Aged; Carcinoma, Squamous Cell; Female; Humans; Isotretinoin; Keratoacanthoma; Leg; Skin Diseases; Skin Neoplasms; Tretinoin

Topics: Administration, Oral; Adult; Foot Dermatoses; Foot Diseases; Humans; Isotretinoin; Keratoacanthoma; Male; Neoplasms, Multiple Primary; Skin Neoplasms; Tretinoin