Keratoacanthoma management: results of a survey of U.K. dermatologists and surgeons

Abstract

Distinction of keratoacanthoma (KA) from squamous cell carcinoma (SCC) is challenging and management is controversial, with some advocating prompt surgical excision and others monitoring to allow for spontaneous resolution.1 There are rare reports of metastasis.2 And yet, the benign natural history of KA is supported by various studies, including a systematic review of 455 cases with no metastasis or death1 and observational studies confirming spontaneous resolution.1 Unlike in SCC, perineural or venous invasion in KA is not associated with an adverse outcome.3,4 Comparative genomic hybridization and DNA microarray studies indicate that KA and SCC are genetically distinct.5,6 Some have suggested that the rare reports of metastatic KA may have arisen from SCC development within KA.3

Our online 22‐item questionnaire ascertained clinicians’ views about KA and its management, previously observed outcomes and willingness to enrol patients into a proposed clinical trial (the questionnaire and further details of results are available from the authors on request). The questionnaire was circulated via the British Association of Dermatologists, the British Society for Dermatological Surgery, Reconstructive Surgery Trials Network, U.K. Dermatology Clinical Trials Network and the national trainee electronic mailing lists. Of 223 respondents 162 (73%) were consultants. Responses to a subset of questions were compared between specialties (dermatology n = 152; dermatological surgery n = 48; and plastic surgery n = 21) with χ2‐ or Fisher's exact test (SPSS Version 22, IBM, Armonk, NY, U.S.A.).