Aggressive giant keratoacanthoma of the face treated with intramuscular methotrexate and triamcinolone acetonide

Keratoacanthoma is a common skin tumor characterized by rapid growth of a smooth dome-shaped nodule with a central plug of keratin, usually followed by spontaneous involution. We report the case of a giant keratoacanthoma on the face that continued to spread peripherally for several months despite vigorous therapeutic intervention. Treatment with methotrexate (25 mg intramuscularly) and Kenalog (triamcinolone acetonide, 40 mg intramuscularly) weekly finally slowed and stopped the expanding, deforming tumor growth and induced involution.