KURT POSTUNDA KOYUN MU VEYA KOYUN KOYUN POSTUNDA KURT MU? KERATOAKANTOM

Yıl 2020, Cilt: 8 Sayı: 2, 107 - 116, 23.08.2020

Fatma Bilgen , Alper Ural , Mehmet Bekerecioğlu

https://doi.org/10.37696/nkmj.652935

Öz

Keratoakantom (KA), ciltten 1-2 cm yükseklikte, kubbe şeklinde, santral bölgede keratinöz plak ile dolu krateri olan pembe renkli benign bir cilt tümörü olarak tanımlanabilir. Genellikle güneş gören alanlarda saç foliküllerinden köken aldığı varsayılmaktadır.KA hakkındaki en yaygın tartışma ise malign ve benign arasındaki durumu ile ilgili olup, bu durum bir klinisyen için zorlayıcı, araştırmacı için de ilginç olabilmektedir. Çünkü bu tümör kanser regresyonunun anlaşılmasında anahtar rol oynayabilir. Keratoakantom, hem klinik hem de histolopatolojik bulgularda skuamöz hücreli karsinom benzerlik göstermekte ve tanı konulurken karıştırılabilmektedir4,5.
Bu karışıklıktan dolayı keratoakantomlar kurt görünümlü koyun olarak tanımlanabilirken, son zamanlarda SCC öncüsü görüşü artması nedeniyle koyun görünümlü kurt olarak da düşünülebilir.
Biopsi materyalinin, subkütanöz yağ dokusununu içeren, total ya da kısmi eksizyonunu ya da merkezi ve her iki tarafı da dahil olmak üzere KA'nın tamamı boyunca tüm lezyonu temsil edecek şekilde fusiform kısmi eksizyon yapılmasını önermişlerdir. Buna ilave olarak da her iki yanda sağlam deriden en az 2 mm biyopsi materyalinde kalacak şekilde eksizyon uygulanmalıdır

Anahtar Kelimeler

keratoakantom, malign, benign

A SHEEP IN WOLF’S CLOTHING, OR A WOLF IN SHEEP’S CLOTHING? KERATOACHANTOMA

Öz

A Keratoacanthoma (KA) is a dome-shaped, pink-colored benign skin tumor, around 1–2 cm in height with a central crater filled with keratinous plaque, that is assumed to be caused by the exposure of hair follicles to sunlight. The most prominent discussion on KA is whether it is malignant or benign, and this discussion is challenging for a clinician and absorbing for a researcher, asit can play a key role in understanding cancer regression. KAs resemble squamous cell carcinomas, both clinically and histologically and in the resulting confusion, KA can be defined as a sheep in wolf’s clothing, but can also be regarded as the wolf in the sheep’s clothing, as there is an emerging view that it could be the precursor to SCC. A total or partial excision of the biopsy material, including subcutaneous fat tissue, or a fusiform partial excision, including the center and both sides along the entire course of the lesion, to represent the whole lesion. In addition, the excised biopsy material should include at least 2 mm of intact skin on both sides.

Anahtar Kelimeler

keratoachantoma, malign, benign

Kaynakça

• 1. Schwartz RA. Keratoacanthoma: a clinico-pathologic enigma. Dermatol Surg. 2004;30:326-333.
• 2. Hutchinson J. Morbid growths and tumors: 1: the “crateriform ulcer of the face” a form of acute epithelial cancer. Trans PatholSoc London. 1889;40:275–281.
• 3. Ramselaar CG, Ruitenberg EJ, Kruizinga W. Regression of induced keratoacanthomas in anagen (hair growth phase) skin grafts in mice. Cancer Res. 1980;40:1668-1673.
• 4. Iyengar B, Ramesh V. Hair cycle and the histogenesis of pillar tumors. Indian J Cancer. 1989;26:1-9.
• 5. Kwick B, Schwartz RA. Keratoacanthoma (KA): An update and review. J Am AcadDermatol. 2016;74:1220-1233.
• 6. Mandrell JC, Santa Cruz D. Keratoacanthoma: hyperplasia, benign neoplasm, or a type of squamous cell carcinoma? SeminDiagnPathol. 2009;26:150–163.
• 7. Weedon D, Malo J, Brooks D, Williamson R. Squamous cell carcinoma arising in keratoacanthoma: a neglected phenomenon in the elderly. Am J Dermatopathol 2010; 32: 423–426
• 8. Rosendahl C, Cameron A, Argenziano G, Zalaudek I, Tschandl P, Kittler H. Dermoscopy of squamous cell carcinoma and keratoacanthoma. Arch Dermatol. 2012;148(12):1386-1392.
• 9. Walder BK, Robertson MR, Jeremy D. Skin cancer and immunosuppression. Lancet. 1971;2:1282-1283.
• 10. Kambayashi Y, Fujimura T, Aiba S. Comparison of immunosuppressive and immunomodulatory cells in keratoacanthoma and cutaneous squamous cell carcinoma. ActaDermVenereol. 2013;93:663-668.
• 11. Kerschmann RL, McCalmont TH, LeBoit PE. p53Oncoprotein expression and proliferation index in keratoacanthoma and squamous cell carcinoma. Arch Dermatol. 1994;130:181-186.
• 12. Connolly M, Narayan S, Oxley J, de Berker DA. Immunohistochemical staining for the differentiation of subungual keratoacanthoma from subungual squamous cell carcinoma. ClinExpDermatol. 2008;33:625-628.
• 13. Ghadially FN, Barton BW, Kerridge DF. The etiology of keratoacanthoma. Cancer. 1963;16:603-611.
• 14. Carr RA, Houghton JP. Histopathologists' approach to keratoacanthoma: a multisite survey of regional variation in Great Britain and Ireland. J ClinPathol. 2014;67:637–638.
• 15. Goldberg LH, Silapunt S, Beyrau KK, Peterson SR, Friedman PM, Alam M. Keratoacanthoma as a postoperative complication of skin cancer excision. J Am AcadDermatol. 2004;50:753-758.
• 16. Zito G, Saotome I, Liu Z. et al. Spontaneous tumor regression in keratoacanthomas is driven byWnt/retinoic acid signaling cross-talk. Nat Commun. 2014;5:3543-3551.
• 17. Chowdhury S, Bandyopadhyay D, Mondal AK. Generalized eruptive keratoacanthoma of Grzybowski. Skinmed. 2015;13(2):148-150.
• 18. Karaa A, Khachemoune A. Keratoacanthoma: a tumor in search of a classification. Int J Dermatol 2007; 46:671-679.
• 19. Dabska M, Madejczykowa A. Rogowiakkolczastokomorkowy: keratoacanthoma (molluscum sebaceum, molluscum pseudocarcinomatosum). Studiumpatologiczno-kliniczne. Nowotwory.1959;9:1-23.
• 20. Miedzinski F, Kozakiewicz J. Keratoacanthoma centrifugume a special variety of keratoacanthoma [in German]. Hautarzt. 1962;13:348-352.
• 21. Divers AK, Correale D, Lee JB. Keratoacanthoma centrifugum marginatum: a diagnostic and therapeutic challenge. Cutis. 2004;73:257-262.
• 22. Khaled A, Kourda M, Fazaa B, Zermani R, Kamoun MR. Multiple keratoacanthoma centrifugum marginatum. Dermatol Online J. 2010;16:16-21.
• 23. Grzybowski M. A case of peculiar generalized epithelial tumors of the skin. Br J DermatolSyphil. 1950;62:310-313.
• 24. Ferguson Smith J. A case of multiple primary squamous-celled carcinomata of the skin in a young man, with spontaneous healing. Br J DermatolSyphil. 1934;46:267-272.
• 25. Takai T, Misago N, Murata Y. Natural course of keratoacanthoma and related lesions after partial biopsy: clinical analysis of 66 lesions. J Dermatol 2015; 42: 353–362.
• 26. Kossard S, Tan KB, Choy C. Keratoacanthoma and infundibulo cystic squamous cell carcinoma. Am J Dermatopathol 2008; 30: 127–134.
• 27. Misago N, Takai T, Toda S, Narisawa Y. Thechanges in the expression levels of follicular markers in keratoacanthoma depend on the stage: keratoacanthoma is a follicular neoplasm exhibiting infundibular/isthmic differentiation without expression of CK15. J CutanPathol 2014; 41: 437–446.
• 28. Misago N, Takai T, Toda S, Narisawa Y. The histopathologic changes in keratoacanthoma depend on its stage. J CutanPathol. 2014; 41: 617–619.
• 29. Cribier B, Asch P, Grosshans E. Differentiating squamous cell carcinoma from keratoacanthoma using histopathological criteria. Is it possible? A study of 296 cases. Dermatology. 1999;199:208-212.
• 30. Sanchez Yus E, Simon P, Requena L, Ambrojo P, de Eusebio E. Solitary keratoacanthoma: a self-healing proliferation that frequently becomes malignant. Am J Dermatopathol. 2000; 22:305-310.
• 31. Misago N, Inoue T, Koba S, Narisawa Y. Keratoacanthoma and other types of squamous cell carcinoma with crateriform architecture: classification and identification. J Dermatol 2013; 40: 443– 452.
• 32. Ogita A, Ansai SI, Misago N, Anan T, Fukumoto T, Saeki H. Histopathological diagnosis of epithelial crateriform tumors: keratoacanthoma and other epithelial crateriform tumors. J Dermatol 2016; 43: 1321–1331.
• 33. Kern WH, McCray MK. The histopathologic differentiation of keratoacanthoma and squamous cell carcinoma of the skin. J CutanPathol. 1980;7:318-325.
• 34. Phillips P, Helm KF. Proliferating cell nuclear antigen distribution in keratoacanthoma and squamous cell carcinoma. J CutanPathol. 1993;20:424-428.
• 35. Savage JA, Maize JC. Keratoacanthoma Clinical Behavior: A Systematic Review. Am J Dermatopathol 2014;36(5):422–429.
• 36. Griffiths RW. Keratoacanthoma observed. Br J Plast Surg. 2004;57:485–501.
• 37. Hodak E, Jones RE, Ackerman AB. Solitary keratoacanthoma is a squamous-cell carcinoma: three examples with metastases. Am J Dermatopathol. 1993;15:332–352.
• 38. Schell AE, Russell MA, Park SS. Suggested excisional margins for cutaneous malignant lesions based on Mohs micrographic surgery. JAMA Facial Plast Surg. 2013;15:337–343.
• 39. Klein E, Helm F, Milgrom H, Stoll HL, JrTraenkle HL. Tumors of the skin. II. Keratoacanthoma; local effect of 5-fluorouracil. Skin. 1962;1:153–156.
• 40. LaPresto L, Cranmer L, Morrison L, Erickson CP, Curiel-Lewandrowski C. A novel therapeutic combination approach for treating multiple vemurafenib-induced keratoacanthomas: systemic acitretin and intralesional fluorouracil. JAMA Dermatol. 2013;149:279–281.
• 41. Aubut N, Alain J, Claveau J. Intralesional methotrexate treatment for keratoacanthoma tumors: a retrospective case series. J Cutan Med Surg. 2012;16:212–217.
• 42. Campalani E, Holden CA. Keratoacanthoma associated with the use of topical imiquimod. ClinExpDermatol. 2013;38:555-556.
• 43. Pini AM, Koch S, Scharer L, French LE, Lauchli S, Hofbauer GF. Eruptive keratoacanthoma following topical imiquimod for insitu squamous cell carcinoma of the skin in a renal transplant recipient. J Am AcadDermatol. 2008;59(Suppl):116-117.
• 44. Gogia R, Grekin RC, Shinkai K. Eruptive self-resolving keratoacanthomas developing after treatment with photo dynamic therapy and microdermabrasion. Dermatol Surg. 2013;39: 1717-1720.
• 45. Street ML, White JW, Jr Gibson LE. Multiple keratoacanthomas treated with oral retinoids. J Am AcadDermatol. 1990;23:862–866.
• 46. Reid DC, Guitart J, Agulnik M, Lacouture ME. Treatment of multiple keratoacanthomas with erlotinib. Int J ClinOncol. 2010;15:413–415.
• 47. Nofal A, Assaf M, Ghonemy S, Nofal E, Yosef A. Generalized eruptive keratoacanthoma: a diagnostic and therapeutic challenge. Int J Dermatol. 2015;54:160–167.
• 48. Stevanović D, Krunić A. Keratoacanthoma: a dangerous trap. in: E. Panconesi (Ed.) Dermatology in Europe Proceedings of the First Congress of the European Academy of Dermatology and Venereology, Florence, Italy September 25-28, 1989. Black well Scientific, Oxford; 1991:390–392.
• 49. Lapins NA, Helwig EB. Perineural invasion by keratoacanthoma. ArchDermatol. 1980;116:791-793.
• 50. Basoglu Y, Metze D, Nashan D, Stander S. Keratoacanthoma with perineural invasion: an indicator for aggressive behavior? J DtschDermatolGes. 2008;6:952-955.