Intralesional methotrexate in keratoacanthoma of the nose

Keratoacanthomas are rapidly growing benign cutaneous neoplasms, usually occurring on sun-exposed areas of the body. Although many treatment modalities have been described, surgical excision is currently the treatment of choice for the majority of keratoacanthomas. Occasionally, however, the size and location of these lesions preclude complete excision without extensive reconstruction and/or scarring. Two such cases of large keratoacanthoma of the nose were treated successfully with intralesional methotrexate. The rapid regression and very acceptable final cosmetic result suggest that intralesional methotrexate may play a beneficial role in the treatment of these difficult lesions and encourage further study of the benefits of this treatment modality.