Martorell-Calatayud A, Requena C, Nagore E, Sanmartín O, Serra-Guillén C, Botella-Estrada R, Sanz-Motilva V, Llombart B, Alcañiz-Moscardo A, Guillén-Barona C
Departamento de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
Actas Dermosifiliogr. 2011 Oct;102(8):605-15. doi: 10.1016/j.ad.2011.03.013. Epub 2011 Jul 13.
Keratoacanthoma is currently considered to be an in situ squamous cell carcinoma that mainly affects patients over 70 years of age. The tumor has a good prognosis and, in some cases, can resolve spontaneously. Treatment involves simple excision. However, since the tumors generally occur on the face or extremities and display rapid growth, aggressive surgery may be required and the cosmetic results may be poor.
The primary study objective was assessment of the efficacy of presurgical intralesional methotrexate infiltration to reduce the size of the tumor and the corresponding surgical defect.
A prospective, randomized study was undertaken in patients with a diagnosis of keratoacanthoma of at least 1.5 cm who were seen in our service between January 2009 and January 2010. Two groups were established: one receiving a single infiltration of methotrexate prior to surgery and another that did not receive methotrexate.
Of the 25 patients included in the study, 10 received neoadjuvant intralesional methotrexate (group A) and 15 underwent surgery without prior infiltration of methotrexate (group B). The patients in group A displayed a reduction of between 50% and 80% in the size of the lesion prior to surgery. No complications were observed either in relation to methotrexate infusion or surgery. In group B, only 1 patient had a slight reduction in the dimensions of the lesion prior to surgery. In the remaining cases, the lesions remained similar (4 cases, 26%) or had increased in size (10 cases, 66%) at the time of surgery. Five patients in this group required hospital admission following surgery.
Neoadjuvant intralesional methotrexate is well tolerated and reduces the need for aggressive surgery in elderly patients with keratoacanthoma measuring more than 1.5 cm on the face or extremities.
角化棘皮瘤目前被认为是一种原位鳞状细胞癌，主要影响70岁以上的患者。该肿瘤预后良好，在某些情况下可自发消退。治疗方法为简单切除。然而，由于肿瘤通常发生在面部或四肢，且生长迅速，可能需要进行根治性手术，且美容效果可能不佳。
主要研究目的是评估术前瘤内注射甲氨蝶呤缩小肿瘤大小及相应手术缺损的疗效。
对2009年1月至2010年1月期间在我院就诊、诊断为角化棘皮瘤且肿瘤直径至少1.5 cm的患者进行了一项前瞻性随机研究。分为两组：一组在手术前接受单次甲氨蝶呤注射，另一组未接受甲氨蝶呤注射。
研究纳入的25例患者中，10例接受了新辅助瘤内注射甲氨蝶呤（A组），15例未进行甲氨蝶呤注射直接接受手术（B组）。A组患者术前病变大小缩小了50%至80%。未观察到与甲氨蝶呤注射或手术相关的并发症。B组中，只有1例患者术前病变尺寸略有缩小。在其余病例中，手术时病变大小保持不变（4例，26%）或增大（10例，66%）。该组有5例患者术后需要住院治疗。
新辅助瘤内注射甲氨蝶呤耐受性良好，可减少对面部或四肢直径超过1.5 cm的老年角化棘皮瘤患者进行根治性手术的需求。
