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Year : 2011  |  Volume : 56  |  Issue : 4  |  Page : 455-456
Keratoacanthoma centrifugum marginatum: Case report and review of literature


Department of Dermatology, Smt. N H L Medical College, V.S. Hospital, Ahmedabad, India

Date of Web Publication10-Sep-2011

Correspondence Address:
Piyush B Borkhatariya
Department of Dermatology, Smt. N H L Medical College, V.S. Hospital, Ahmedabad
India
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DOI: 10.4103/0019-5154.84719

PMID: 21965871

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How to cite this article:
Borkhatariya PB, Gupta S, Bang D, Rawal RC. Keratoacanthoma centrifugum marginatum: Case report and review of literature. Indian J Dermatol 2011;56:455-6

How to cite this URL:
Borkhatariya PB, Gupta S, Bang D, Rawal RC. Keratoacanthoma centrifugum marginatum: Case report and review of literature. Indian J Dermatol [serial online] 2011 [cited 2014 Sep 16];56:455-6. Available from: http://www.e-ijd.org/text.asp?2011/56/4/455/84719


Sir,

Keratoacanthoma centrifugum marginatum (KCM) is an uncommon variant of keratoacanthoma (KA), commonly solitary. It is characterized by progressive peripheral expansion and concomitant central healing leaving atrophy. We describe here a case of 65-year-old male with KA on extensor of leg since 2 years.

A 65-year-old male presented to us with single large plaque on extensor of leg since 2 years. Patient has history of multiple applications of various topical medications with no or little improvement. On examination single 7 × 3 cm cup-shaped lesion with central necrosis and raised margin which was mildly hyperkeratotic was seen [Figure 1]. A radial biopsy was taken from the lesion under local anesthesia and processed for histological observation. Biopsy showed tumor to be composed of central keratin-filled crater with butteress like extension of surrounding epidermis [Figure 2]. There is downward proliferation of epidermis from the base of crater which showed minimal nuclear atypia and few mitosis in basal layer. Dense inflammatory infiltration was present at the base of the lesion and shrunken eosinophilic cells among the tumor cells. Based on these architectural and cytological features, the diagnosis of KCM was considered. Patient was referred to plastic surgery department for excision and grafting.
Figure 1: It shows single cup - shaped lesion with hyperkeratotic border on the leg

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Figure 2: Biopsy showed tumor to be composed of central keratin-filled crater with butteress like extension of surrounding epidermis

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KA is a rapidly growing tumor with a well-defined cycle of growth eventually ending in spontaneous involution. [1],[2] Besides the common solitary form, a few less frequent variants have been recognized. Mutations of the tumor suppressor gene p53, which normally regulates cell proliferation by inhibiting cells from entering the S-phase, have been suggested in classic cases of keratoakanthoma. [3] In addition to the main type, several variants of KA exist and are characterized by lack of spontaneous regression and progressive destructive growth. Clinically, three types of the persisting, destructive variant of KA can be distinguished: Mutilating KA, aggregated KA, the KCM. Unlike squamous cell carcinomas (SCC), which develop from normal epidermal keratinocytes, KA are derived from the supraseboglandular parts of hair follicles. The KCM was first described in 1965 by Belisario as a separate entity. [3] Histologically these tumors often comprise infiltrative behavior, and atypical mitoses may be seen occasionally. [4],[5] In our case the diagnosis of a KCM could be made because of the clinical course with centrifugal expansion in association with central restitution or scarring and because of the typical histology. The treatment of choice for all types of KAs is still the surgical excision with histopathological verification of the diagnosis. If surgery is not possible a radiation therapy with tumor doses can be considered. Several other therapeutic options such as intralesional injections of interferon alpha, methotrexate or bleomycin, and systemically administered retinoids have been reported to be effective in individual cases, but there are no controlled clinical studies demonstrating the efficiency of these treatments so far.

 
   References Top

1.Kingman J, Callen JP. Keratoacanthoma: A clinical study. Arch Dermatol 1984;120:736-40.  Back to cited text no. 1
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2.Mantegna M, Iuculano MF. Seasonality of keratoacanthomas. Arch Dermatol 1995;131:1902.  Back to cited text no. 2
    
3.Stephenson TJ, Royds J, Silcocks PB, Bleehen SS. Mutant p53 oncogene expression in keratoacanthoma and squamous cell carcinoma. Br J Dermatol 1992;127:566-70  Back to cited text no. 3
    
4.Belisario JC. Brief review of keratoacanthomas and description of keratoacanthoma centrifugum marginatum. Aust J Dermatol 1965;8:65-75.  Back to cited text no. 4
[PUBMED]    
5.Janecka IP, Wolff M, Crickelair GF, Cosmann B: Aggressive histological features of keratoacanthoma. J Cutan Pathol 1977;4:342-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]

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