Keratoacanthoma centrifugum marginatum: unresponsive to oral retinoid and successfully treated with wide local excision.

Abstract

We describe a case of a 65-year-old male presenting with a large plaque with a rolled-out interrupted margin, atrophic center, and island of normal skin over the left arm. It grew peripherally with central healing, and there was a history of recurrence after inadequate excision. Investigations ruled out other clinical mimickers; namely, squamous cell carcinoma, lupus vulgaris, botryomycosis, and blastomycosis-like pyoderma. Histopathological sections showed irregularly shaped craters filled with keratin and epithelial pearl but no evidence of granuloma or cellular atypia. Clinicopathological correlation proved the lesion to be keratoacanthoma centrifugum marginatum (KCM), a rare variant of keratoacanthoma, which spreads centrifugally, attains a huge size, and never involutes spontaneously. Treatment of KCM has been a problem always and, in our case, systemic retinoid (acitretin for three months) proved ineffective. The patient also had a history of recurrence following surgical intervention previously, necessitating wide excision to achieve complete clearance of tumor cells. Hence, after failure of retinoid therapy, the decision of excision with a 1-centimeter margin was taken and the large defect was closed by a split thickness skin graft. The graft uptake was satisfactory, and the patient is being followed-up presently and shows no signs of recurrence after six months, highlighting wide local excision as a useful treatment option.

Keratoacanthoma centrifugum marginatum associated with mechanical trauma: Response to acitretin—A case report and review of the literature

“…Our patient had a good and prompt response to acitretin. However, Mangas et al 13 and Das et al 14 reported failure of oral retinoids in their patients. Patients successfully treated with oral retinoids are summarized in Table 2.…”

Keratoacanthoma Centrifugum Marginatum (KCM) after photodynamic therapy with good response to oral retinoids and topical 5‐fluorouracil

“…Some cases treated with oral retinoids (Acitretin, Etretinate or Isotretinoin in doses between 0.5 and 1 mg/kg/day) with a good response (Georgescu et al, ; Mehrtens, de la Hera, & Shankar, ) have been reported. One case without response oral retinoids has been successfully treated with wide local excision (Das et al, ). Mohs surgery, conventional surgery, PDT, or radiotherapy has also been used (Lindsay, Kharofa, Junck, Olasz, & Frank Wilson, ; Sung et al, ).…”

Keratoacanthoma centrifugum marginatum at an unusual site

“…It is hypothesized that this typical appearance may arise as a result of sequential involvement of multiple adjacent hair follicles in a centrifugal fashion. [9]…”