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Keratoacanthoma clinical behavior: a systematic review.

Jacqueline A Savage1, John C Maize

  • 1Departments of *Pathology and Laboratory Medicine, College of Medicine, and †Dermatology, Medical University of South Carolina, Charleston, SC.

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|December 25, 2013
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Keratoacanthomas (KAs) are benign epidermal growths, not malignant squamous cell carcinoma (SCC). A review of 445 KA cases found no deaths or distant metastases, unlike SCC skin cancer.

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Area of Science:

  • Dermatology
  • Pathology
  • Oncology

Background:

  • Keratoacanthomas (KAs) have been controversially classified as either benign or malignant.
  • Some researchers assert KAs are a form of squamous cell carcinoma (SCC).
  • Lack of clear diagnostic criteria and understanding of KA etiology complicates classification.

Purpose of the Study:

  • To investigate the biologic behavior and metastatic potential of keratoacanthomas.
  • To compare the clinical outcomes of KAs with those of squamous cell carcinoma (SCC).
  • To clarify the classification of KAs as benign or malignant entities.

Main Methods:

  • Systematic review and data extraction from 113 published articles.
  • Analysis of 445 cases of keratoacanthoma with reported follow-up and outcomes.
  • Comparative analysis with 429 reported cases of skin squamous cell carcinoma (SCC).

Main Results:

  • None of the 445 reviewed keratoacanthoma cases resulted in death or distant metastases.
  • In contrast, 61 cases of squamous cell carcinoma (SCC) showed metastases, and 24 deaths were directly attributed to SCC.
  • The distinct clinical behaviors differentiate KAs from SCC.

Conclusions:

  • Keratoacanthomas exhibit benign biologic behavior.
  • KAs are distinct epidermal growths and not a malignant variant of squamous cell carcinoma (SCC).
  • The findings support the classification of KAs as benign lesions.