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Keratoacanthoma: Management and prognosis

Jerry D Brewer, MD
Section Editor
June K Robinson, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Keratoacanthoma (KA) is a cutaneous squamoproliferative tumor that usually presents as a 1 to 2 cm dome-shaped or crateriform nodule with central hyperkeratosis (picture 1A-E). A common and distinctive feature of KA is a clinical course characterized by phases of rapid growth, lesion stability, and spontaneous involution.

The approach to the management of KA is debatable since lesions can resolve without treatment. However, the well-accepted difficulty in distinguishing KA from cutaneous squamous cell carcinoma, a common tumor associated with a risk for metastasis, leads many clinicians (including ourselves) to recommend treatment of these lesions.

The treatment and prognosis of KA will be discussed here. The epidemiology, risk factors, and diagnosis of KA are reviewed separately. (See "Keratoacanthoma: Epidemiology, risk factors, and diagnosis".)


A longstanding debate over the classification of KA as a benign, spontaneously resolving tumor versus a variant of cutaneous squamous cell carcinoma with a rare potential for metastasis has contributed to a lack of definitive guidelines on the treatment of these lesions. Although most authors, including ourselves, advocate for treatment of KA [1-7], observation until spontaneous resolution has also been used for management of these lesions [4,8]. (See "Keratoacanthoma: Epidemiology, risk factors, and diagnosis", section on 'Relationship with squamous cell carcinoma'.)

We opt to treat KA based upon the following considerations [2]:


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Literature review current through: Sep 2016. | This topic last updated: Jun 25, 2015.
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