Intralesional methotrexate (IL-MTX) is an effective treatment for keratoacanthoma.
Objective:
We sought to determine the response rates and adverse events in KA treated with intralesional methotrexate.
Methods:
All cases of KA treated with intralesional methotrexate at our institutions from 2001 to 2009 were systematically reviewed.
Results:
Forty-six cases of KA treated with IL-MTX were identified. A complete resolution was achieved in 74% of patients, requiring an average of 1.8 injection sessions, for a mean total dose of 10 mg. Adverse events did not occur.
Limitations:
The follow-up period was short, and there was no histologic confirmation of the initial diagnosis.
Conclusion:
IL-MTX is an effective and well-tolerated alternative to surgery for the treatment of KA.
Get full access to this article
View all access options for this article.
References
1.
BehamA, RegauerS, SoyerHP, Beham-Schmid C. Keratoacanthoma: a clinically distinct variant of well-differentiated squamous cell carcinoma. Adv Anat Pathol1998;5:5-269, doi:10.1097/00125480-199809000-00001.
2.
MansteinCH, FrauenhofferCJ, BesdenJE.Keratoacanthoma: is it a real entity? Ann Plast Surg1998;40:40-469, doi:10.1097/00000637-199805000-00004.
3.
RapiniRP.Practical dermatopathology. New York: Elsevier Mosby, 2005.
4.
Wilsmann-TheisD, WenzelJ, BettenHH. A rapidly growing squamous cell carcinoma or keratoacanthoma or both? Acta Derm Venereol2007;87:87-447, doi:10.2340/00015555-0294.
5.
GoldenhershMA, OlsenTG.Invasive squamous cell carcinoma initially diagnosed as a giant keratoacanthoma. J Am Acad Dermatol1984;10:10-372, doi:10.1016/S0190-9622(84)80010-9.
6.
CribierB.Keratoacanthoma? Better to say “squamous cell carcinoma, keratoacanthoma type.” Ann Dermatol Venereol2008;135:135-541, doi:10.1016/j.annder.2008.03.001.
7.
MandrellJC, Santa Cruz D. Keratoacanthoma: hyperplasia, benign neoplasm, or a type of squamous cell carcinoma? Semin Diagn Pathol2009;26:26-150, doi:10.1053/j.semdp.2009.09.003.
8.
KoCJ.Keratoacanthoma: facts and controversies. Clin Dermatol2010;28:28-254, doi:10.1016/j.clindermatol.2009.06.010.
9.
AnnestNM, VanBeekMJ, ArpeyCJ, WhitakerDC.Intralesional methotrexate treatment for keratoacanthoma tumors: a retrospective study and review of the literature. J Am Acad Dermatol2007;56:56-989, doi:10.1016/j.jaad.2006.12.017.
10.
LarsonPO.Keratoacanthomas treated with Mohs' micrographie surgery: a review of forty-three cases. J Am Acad Dermatol1987;16:16-1040, doi:10.1016/S0190-9622(87)70134-0.
11.
WongWY, KolbuszRV, GoldbergLH, GuanaA.Treatment of recurrent keratoacathoma with oral isotretinoin. Int J Dermatol1994;33:33-579, doi:10.1111/j.1365-4362.1994.tb02902.x.
12.
GoldschmidtH, SherwinWK.Radiation therapy of giant aggressive keratoacanthomas. Arch Dermatol1993;129:129-1162, doi:10.1001/archderm.1993.01680300090014.
13.
ReymannF.Treatment of keratoacanthomas with curettage. Dermatologica1997;155:155-90, doi:10.1159/000250961.
14.
NedwichJA.Evaluation of curettage and electrodesiccation in treatment of keratoacanthoma. Australas J Dermatol1991;32:32-137, doi:10.1111/j.1440-0960.1991.tb01777.x.
15.
DendorferM, OppelT, WollenbergA, PrinzJC.Topical treatment with imiquimod may induce regression of facial keratoacanthoma. Eur J Dermatol2003;13:13-80.
16.
ParkerCM, HankeCW.Large keratoacanthomas in difficult locations treated with intralesional 5-fluorouracil. J Am Acad Dermatol1986;14:14-770, doi:10.1016/S0190-9622(86)70092-3.
17.
MeltonJL, NelsonBR, StoughDB. Treatment of keratoacanthomas with intralesional methotrexate. J Am Acad Dermatol1991;25:25-1017, doi:10.1016/0190-9622(91)70301-H.
18.
HurstLN, GanBS.Intralesional methotrexate in keratoacanthoma of the nose. Br J Plast Surg1995;48:48-243, doi:10.1016/0007-1226(95)90010-1.
19.
Cuesta-RomeroC, de Grado-Pena J. Intralesional methotrexate in solitary keratoacanthoma. Arch Dermatol1998;134:134-513, doi:10.1001/archderm.134.4.513.
20.
RemlingR, MempelM, SchnoppN. Intralesional methotrexate injection: an effective time and cost saving therapy alternative in keratoacanthomas that are difficult to treat surgically. Hautarzt2000;51:51-612, doi:10.1007/s001050051180.
21.
SpiethK, GilleJ, KaufmannR.Intralesional methotrexate as effective treatment in solitary giant keratoacanthoma of the lower lip. Dermatology2000;200:200-317, doi:10.1159/000018395.
22.
RichardMA, GachonJ, ChouxR. Treatment of keratoacanthoma with intralesional methotrexate injections. Ann Dermatol Venereol2000;127:1097.
23.
de VisscherJG, van der WalKG, BlankenR, WillemseF.Treatment of giant keratoacanthoma of the lower lip with intralesional methotrexate: a case report. J Oral Maxillofac Surg2002;60:60-93, doi:10.1053/joms.2002.29083.
24.
CohenPR, SchulzeKE, TellerCF, NelsonBR.Intralesional methotrexate for keratoacanthoma of the nose. Skinmed2005;4:4-393, doi:10.1111/j.1540-9740.2005.03866.x.
25.
GoebelerM, LurzC, Kolve-GoebelerME, BrockerEB.Pancytopenia after treatment of keratoacanthoma by a single lesional methotrexate infiltration. Arch Dermatol2001;137:137-1104.
26.
CohenPR, SchulzeKE, NelsonBR.Pancytopenia after a single intradermal infiltration of methotrexate. J Drugs Dermatol2005;4:4-648.
27.
OlsenEA.The pharmacology of methotrexate. J Am Acad Dermatol1991;25:25-306, doi:10.1016/0190-9622(91)70199-C.
