Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

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]:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: May 10, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Jackson IT. Diagnostic problem of keratoacanthoma. Lancet 1969; 1:490.
  2. Karaa A, Khachemoune A. Keratoacanthoma: a tumor in search of a classification. Int J Dermatol 2007; 46:671.
  3. Kingman J, Callen JP. Keratoacanthoma. A clinical study. Arch Dermatol 1984; 120:736.
  4. Browne F, O'Connell M, Merchant W, et al. Spontaneous resolution of a giant keratoacanthoma penetrating through the nose. Clin Exp Dermatol 2011; 36:369.
  5. Ko CJ. Keratoacanthoma: facts and controversies. Clin Dermatol 2010; 28:254.
  6. Schwartz RA. Keratoacanthoma: a clinico-pathologic enigma. Dermatol Surg 2004; 30:326.
  7. Schwartz RA. Keratoacanthoma. J Am Acad Dermatol 1994; 30:1.
  8. Griffiths RW. Keratoacanthoma observed. Br J Plast Surg 2004; 57:485.
  9. Tran DC, Li S, Henry AS, et al. An 18-year retrospective study on the outcomes of keratoacanthomas with different treatment modalities at a single academic center. Br J Dermatol 2016.
  10. Garcia-Zuazaga J, Ke M, Lee P. Giant keratoacanthoma of the upper extremity treated with mohs micrographic surgery: a case report and review of current treatment modalities. J Clin Aesthet Dermatol 2009; 2:22.
  11. Shriner DL, McCoy DK, Goldberg DJ, Wagner RF Jr. Mohs micrographic surgery. J Am Acad Dermatol 1998; 39:79.
  12. Nedwich JA. Evaluation of curettage and electrodesiccation in treatment of keratoacanthoma. Australas J Dermatol 1991; 32:137.
  13. Cohen PR, Schulze KE, Teller CF, Nelson BR. Intralesional methotrexate for keratoacanthoma of the nose. Skinmed 2005; 4:393.
  14. Annest NM, VanBeek MJ, Arpey CJ, Whitaker DC. Intralesional methotrexate treatment for keratoacanthoma tumors: a retrospective study and review of the literature. J Am Acad Dermatol 2007; 56:989.
  15. Melton JL, Nelson BR, Stough DB, et al. Treatment of keratoacanthomas with intralesional methotrexate. J Am Acad Dermatol 1991; 25:1017.
  16. Kirby JS, Miller CJ. Intralesional chemotherapy for nonmelanoma skin cancer: a practical review. J Am Acad Dermatol 2010; 63:689.
  17. Goette DK, Odom RB. Successful treatment of keratoacanthoma with intralesional fluorouracil. J Am Acad Dermatol 1980; 2:212.
  18. Martorell-Calatayud A, Requena C, Nagore E, et al. [Intralesional infusion of methotrexate as neoadjuvant therapy improves the cosmetic and functional results of surgery to treat keratoacanthoma: results of a randomized trial]. Actas Dermosifiliogr 2011; 102:605.
  19. Andreassi A, Pianigiani E, Taddeucci P, et al. Guess what! Keratoacanthoma treated with intralesional bleomycin. Eur J Dermatol 1999; 9:403.
  20. Sayama S, Tagami H. Treatment of keratoacanthoma with intralesional bleomycin. Br J Dermatol 1983; 109:449.
  21. de la Torre C, Losada A, Cruces MJ. Keratoacanthoma centrifugum marginatum: treatment with intralesional bleomycin. J Am Acad Dermatol 1997; 37:1010.
  22. Rapaport J. Giant keratoacanthoma of the nose. Arch Dermatol 1975; 111:73.
  23. Oh CK, Son HS, Lee JB, et al. Intralesional interferon alfa-2b treatment of keratoacanthomas. J Am Acad Dermatol 2004; 51:S177.
  24. Grob JJ, Suzini F, Richard MA, et al. Large keratoacanthomas treated with intralesional interferon alfa-2a. J Am Acad Dermatol 1993; 29:237.
  25. Goebeler M, Lurz C, Kolve-Goebeler ME, Bröcker EB. Pancytopenia after treatment of keratoacanthoma by single lesional methotrexate infiltration. Arch Dermatol 2001; 137:1104.
  26. Cohen PR, Schulze KE, Nelson BR. Pancytopenia after a single intradermal infiltration of methotrexate. J Drugs Dermatol 2005; 4:648.
  27. Caccialanza M, Sopelana N. Radiation therapy of keratoacanthomas: results in 55 patients. Int J Radiat Oncol Biol Phys 1989; 16:475.
  28. Donahue B, Cooper JS, Rush S. Treatment of aggressive keratoacanthomas by radiotherapy. J Am Acad Dermatol 1990; 23:489.
  29. Shimm DS, Duttenhaver JR, Doucette J, Wang CC. Radiation therapy of keratoacanthoma. Int J Radiat Oncol Biol Phys 1983; 9:759.
  30. Basoglu Y, Metze D, Nashan D, Ständer S. Keratoacanthoma with perineural invasion: an indicator for aggressive behavior? J Dtsch Dermatol Ges 2008; 6:952.
  31. Goldschmidt H, Sherwin WK. Radiation therapy of giant aggressive keratoacanthomas. Arch Dermatol 1993; 129:1162.
  32. Robertson SJ, Bashir SJ, Pichert G, et al. Severe exacerbation of multiple self-healing squamous epithelioma (Ferguson-Smith disease) with radiotherapy, which was successfully treated with acitretin. Clin Exp Dermatol 2010; 35:e100.
  33. Moore AY. Clinical applications for topical 5-fluorouracil in the treatment of dermatological disorders. J Dermatolog Treat 2009; 20:328.
  34. Gray RJ, Meland NB. Topical 5-fluorouracil as primary therapy for keratoacanthoma. Ann Plast Surg 2000; 44:82.
  35. Ebner H, Mischer P. [The local treatment of the keratoacanthoma with 5-fluorouracil]. Hautarzt 1975; 26:585.
  36. Jeon HC, Choi M, Paik SH, et al. Treatment of keratoacanthoma with 5% imiquimod cream and review of the previous report. Ann Dermatol 2011; 23:357.
  37. Neumann RA, Knobler RM. Argon laser treatment of small keratoacanthomas in difficult locations. Int J Dermatol 1990; 29:733.
  38. Thiele JJ, Ziemer M, Fuchs S, Elsner P. Combined 5-fluorouracil and Er:YAG laser treatment in a case of recurrent giant keratoacanthoma of the lower leg. Dermatol Surg 2004; 30:1556.
  39. Alloo A, Garibyan L, LeBoeuf N, et al. Photodynamic therapy for multiple eruptive keratoacanthomas associated with vemurafenib treatment for metastatic melanoma. Arch Dermatol 2012; 148:363.
  40. Mamelak AJ, Goldberg LH, Marquez D, et al. Eruptive keratoacanthomas on the legs after fractional photothermolysis: report of two cases. Dermatol Surg 2009; 35:513.
  41. Gewirtzman A, Meirson DH, Rabinovitz H. Eruptive keratoacanthomas following carbon dioxide laser resurfacing. Dermatol Surg 1999; 25:666.
  42. Bunker CB. Keratoacanthoma, trauma, and cryotherapy. Dermatol Surg 2011; 37:1709.
  43. Kaptanoglu AF, Kutluay L. Keratoacanthoma developing in previous cryotherapy site for solar keratosis. J Eur Acad Dermatol Venereol 2006; 20:197.
  44. Yeon JH, Jung JY, Choi JW, et al. Keratoacanthoma aggravated after photodynamic therapy. J Dermatol 2010; 37:765.
  45. Feldman RJ, Maize JC. Multiple keratoacanthomas in a young woman: report of a case emphasizing medical management and a review of the spectrum of multiple keratoacanthomas. Int J Dermatol 2007; 46:77.
  46. Vandergriff T, Nakamura K, High WA. Generalized eruptive keratoacanthomas of Grzybowski treated with isotretinoin. J Drugs Dermatol 2008; 7:1069.
  47. Aydin F, Senturk N, Sabanciler E, et al. A case of Ferguson-Smith type multiple keratoacanthomas associated with keratoacanthoma centrifugum marginatum: response to oral acitretin. Clin Exp Dermatol 2007; 32:683.
  48. Kato N, Ito K, Kimura K, Shibata M. Ferguson Smith type multiple keratoacanthomas and a keratoacanthoma centrifugum marginatum in a woman from Japan. J Am Acad Dermatol 2003; 49:741.
  49. Benoldi D, Alinovi A. Multiple persistent keratoacanthomas: treatment with oral etretinate. J Am Acad Dermatol 1984; 10:1035.
  50. Haydey RP, Reed ML, Dzubow LM, Shupack JL. Treatment of keratoacanthomas with oral 13-cis-retinoic acid. N Engl J Med 1980; 303:560.
  51. Ogasawara Y, Kinoshita E, Ishida T, et al. A case of multiple keratoacanthoma centrifugum marginatum: response to oral etretinate. J Am Acad Dermatol 2003; 48:282.
  52. Blitstein-Willinger E, Haas N, Nürnberger F, Stüttgen G. Immunological findings during treatment of multiple keratoacanthoma with etretinate. Br J Dermatol 1986; 114:109.
  53. Barysch MJ, Kamarashev J, Lockwood LL, Dummer R. Successful treatment of multiple keratoacanthoma with topical imiquimod and low-dose acitretin. J Dermatol 2011; 38:390.
  54. Cherif F, Mebazaa A, Kort R, et al. [Multiple keratoacanthoma centrifugum marginatum]. Ann Dermatol Venereol 2002; 129:413.
  55. Schaller M, Korting HC, Wolff H, et al. Multiple keratoacanthomas, giant keratoacanthoma and keratoacanthoma centrifugum marginatum: development in a single patient and treatment with oral isotretinoin. Acta Derm Venereol 1996; 76:40.
  56. Shaw JC, Storrs FJ, Everts E. Multiple keratoacanthomas after megavoltage radiation therapy. J Am Acad Dermatol 1990; 23:1009.
  57. Shaw JC, White CR Jr. Treatment of multiple keratoacanthomas with oral isotretinoin. J Am Acad Dermatol 1986; 15:1079.
  58. Sachse MM, Wagner G. Clearance of BRAF inhibitor-associated keratoacanthomas by systemic retinoids. Br J Dermatol 2014; 170:475.
  59. Mangas C, Bielsa I, Ribera M, et al. A case of multiple keratoacanthoma centrifugum marginatum. Dermatol Surg 2004; 30:803.
  60. Oakley A, Ng S. Grzybowski's generalized eruptive keratoacanthoma: remission with cyclophosphamide. Australas J Dermatol 2005; 46:118.
  61. Agarwal M, Chander R, Karmakar S, Walia R. Multiple familial keratoacanthoma of Witten and Zak - A report of three siblings. Dermatology 1999; 198:396.
  62. Sinha A, Marsh R, Langtry J. Spontaneous regression of subungual keratoacanthoma with reossification of underlying distal lytic phalynx. Clin Exp Dermatol 2005; 30:20.
  63. Oliwiecki S, Peachey RD, Bradfield JW, et al. Subungual keratoacanthoma--a report of four cases and review of the literature. Clin Exp Dermatol 1994; 19:230.
  64. Baran R, Goettmann S. Distal digital keratoacanthoma: a report of 12 cases and a review of the literature. Br J Dermatol 1998; 139:512.
  65. Ko CJ, McNiff JM, Bosenberg M, Choate KA. Keratoacanthoma: clinical and histopathologic features of regression. J Am Acad Dermatol 2012; 67:1008.
  66. Ansai S, Manabe M. Possible spontaneous regression of a metastatic lesion of keratoacanthoma-like squamous cell carcinoma in a regional lymph node. J Dermatol 2005; 32:899.
  67. Hodak E, Jones RE, Ackerman AB. Solitary keratoacanthoma is a squamous-cell carcinoma: three examples with metastases. Am J Dermatopathol 1993; 15:332.
  68. Davis BA, Monheit GD, Kline L. Metastatic skin cancer presenting as ptosis and diplopia. Dermatol Surg 2006; 32:148.
  69. Mandrell JC, Santa Cruz D. Keratoacanthoma: hyperplasia, benign neoplasm, or a type of squamous cell carcinoma? Semin Diagn Pathol 2009; 26:150.
  70. Schnur PL, Bozzo P. Metastasizing keratoacanthomas? The difficulties in differentiating keratoacanthomas from squamous cell carcinomas. Plast Reconstr Surg 1978; 62:258.
  71. Godbolt AM, Sullivan JJ, Weedon D. Keratoacanthoma with perineural invasion: a report of 40 cases. Australas J Dermatol 2001; 42:168.
  72. Petrie M, Eliezri Y, Campanelli C. Keratoacanthoma of the head and neck with perineural invasion: incidental finding or cause for concern? Dermatol Surg 2010; 36:1209.
  73. Cooper PH, Wolfe JT 3rd. Perioral keratoacanthomas with extensive perineural invasion and intravenous growth. Arch Dermatol 1988; 124:1397.
  74. Weedon D. Tumors of the epidermis. In: Weedon's Skin Pathology, 3rd Ed, Elsevier Limited, 2010. p.667.