Patel Nima P, Cervino A Lawrence
Division of Plastic and Reconstructive Surgery, Summa Health System, Northeastern Ohio Universities College of Medicine, Akron, Ohio, USA.
Can J Plast Surg. 2011 Summer;19(2):e15-8.
Keratoacanthomas (KAs) are a variant of squamous cell carcinomas. Some KAs have shown aggressive behaviour, leading to metastasis and death. Surgical excision is the treatment of choice for most KA patients. Intralesional methotrexate (MTX) may also be a potential treatment option for KAs.
To evaluate intralesional MTX as a treatment modality for KA.
A retrospective chart review of nine patients with KAs treated with intralesional MTX was performed. Each patient had biopsy-proven KA. The lesion was initially debulked, and MTX was injected at the base. Patients were seen weekly in the office, and reinjected with intralesional MTX depending on the response of the lesion. Each patient was evaluated for their response to the intralesional MTX injections, the number of injections required and complications.
Patients required approximately two to four intralesional injections (12.5 mg to 25 mg per injection) before KA resolution. Eight of nine (88.9%) patients experienced complete resolution of their tumours. One patient experienced treatment failure, and underwent surgical excision of the KA. The average follow-up period was 2.8 years, and there were no recurrences.
The results from the present retrospective study show that intralesional MTX injection is an effective treatment option for KAs. The authors propose that intralesional MTX injection with initial debulking of the KA should be used as a first line of treatment when KAs present on the extremities, in cosmetically sensitive areas and in elderly patients with multiple comorbities.
角化棘皮瘤（KA）是鳞状细胞癌的一种变体。一些KA表现出侵袭性，可导致转移和死亡。手术切除是大多数KA患者的首选治疗方法。瘤内注射甲氨蝶呤（MTX）也可能是KA的一种潜在治疗选择。
评估瘤内注射MTX作为KA的一种治疗方式。
对9例接受瘤内注射MTX治疗的KA患者进行回顾性病历审查。每位患者均经活检证实为KA。首先对病变进行减瘤，然后在病变底部注射MTX。患者每周到门诊就诊，根据病变反应再次注射瘤内MTX。评估每位患者对瘤内注射MTX的反应、所需注射次数及并发症。
KA消退前患者大约需要进行两到四次瘤内注射（每次注射12.5mg至25mg）。9例患者中有8例（88.9%）肿瘤完全消退。1例患者治疗失败，接受了KA的手术切除。平均随访期为2.8年，无复发。
本回顾性研究结果表明，瘤内注射MTX是KA的一种有效治疗选择。作者建议，当KA出现在四肢、美容敏感区域以及患有多种合并症的老年患者中时，应将瘤内注射MTX并初始减瘤作为一线治疗方法。
