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Treatment of keratoacanthoma: Is intralesional methotrexate an option?
Nima P Patel1, A Lawrence Cervino
1Division of Plastic and Reconstructive Surgery, Summa Health System, Northeastern Ohio Universities College of Medicine, Akron, Ohio, USA.
Background:
Keratoacanthomas (KAs) are a variant of squamous cell carcinomas. Some KAs have shown aggressive behaviour, leading to metastasis and death. Surgical excision is the treatment of choice for most KA patients. Intralesional methotrexate (MTX) may also be a potential treatment option for KAs.
Objective:
To evaluate intralesional MTX as a treatment modality for KA.
Methods:
A retrospective chart review of nine patients with KAs treated with intralesional MTX was performed. Each patient had biopsy-proven KA. The lesion was initially debulked, and MTX was injected at the base. Patients were seen weekly in the office, and reinjected with intralesional MTX depending on the response of the lesion. Each patient was evaluated for their response to the intralesional MTX injections, the number of injections required and complications.
Results:
Patients required approximately two to four intralesional injections (12.5 mg to 25 mg per injection) before KA resolution. Eight of nine (88.9%) patients experienced complete resolution of their tumours. One patient experienced treatment failure, and underwent surgical excision of the KA. The average follow-up period was 2.8 years, and there were no recurrences.
Conclusion:
The results from the present retrospective study show that intralesional MTX injection is an effective treatment option for KAs. The authors propose that intralesional MTX injection with initial debulking of the KA should be used as a first line of treatment when KAs present on the extremities, in cosmetically sensitive areas and in elderly patients with multiple comorbities.
Insights
Intralesional methotrexate (MTX) effectively treats keratoacanthomas (KAs), a type of squamous cell carcinoma. This study found 88.9% of patients achieved complete tumor resolution with MTX injections.
Area of Science:
- Dermatology
- Oncology
- Surgical Pathology
Background:
- Keratoacanthomas (KAs) are a subtype of squamous cell carcinoma.
- Aggressive KAs can metastasize and be fatal.
- Surgical excision is the standard treatment, but intralesional methotrexate (MTX) is an alternative.
Purpose of the Study:
- To evaluate the efficacy of intralesional MTX for treating KAs.
- To assess MTX as a potential treatment modality for keratoacanthomas.
Main Methods:
- Retrospective chart review of nine biopsy-proven KA patients.
- Initial debulking followed by intralesional MTX injections at the tumor base.
- Weekly patient follow-up with repeat injections based on lesion response.
Main Results:
- 88.9% of patients achieved complete KA resolution.
- Average of 2-4 injections (12.5-25 mg) were required per patient.
- No recurrences observed during an average 2.8-year follow-up.
Conclusions:
- Intralesional MTX injection is an effective treatment for KAs.
- Consider intralesional MTX with debulking as a first-line therapy for KAs on extremities, sensitive areas, or in elderly patients.
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