School of Humanities and Sciences, Stanford University, Stanford, California.
School of PA Medicine, Graduate Health Sciences, Lynchburg College, Lynchburg, Virginia.
Dermatol Surg. 2019 Jul;45(7):877-883. doi: 10.1097/DSS.0000000000001739.
Keratoacanthomas (KAs) are common tumors of squamous cell origin that grow rapidly and may regress; however, differentiation from an aggressive squamous cell carcinoma is problematic.
To report the authors' experience in managing KA with intralesional methotrexate (MTX) or surgical excision.
The authors collected data on 157 tumors (136 patients) over 6 months from a single institution.
There were 73 tumors (54 patients) treated with intralesional MTX. There were 9 tumors that did not resolve with intralesional MTX (88% cure). Nonresolving tumors were excised with no recurrences or complications. In all 9 cases, the nonresolving tumors were of the same size or smaller after MTX. Of the 73 tumors treated with MTX, 29 tumors (11 patients) were multiple KAs. All 29 tumors resolved (100% tumor clearance). There were no complications in any of the MTX-treated patients. Tumor clearance was defined by clinical resolution for a minimum of 6 weeks without a recurrence. There were 84 tumors (83 patients) treated with surgical excision. There were no complications and no recurrences (100% cure) with surgery.
Intralesional MTX may be considered as the initial treatment for solitary KA, multiple KA, or in poor surgical candidates.
角化棘皮瘤（KA）是一种常见的鳞状细胞来源肿瘤，生长迅速，可能会自行消退；然而，区分其是否为侵袭性鳞状细胞癌具有一定难度。
报告作者采用局部注射甲氨蝶呤（MTX）或手术切除治疗 KA 的经验。
作者在 6 个月内在一家机构收集了 157 个肿瘤（136 例患者）的数据。
73 个肿瘤（54 例患者）接受了局部注射 MTX 治疗。9 个肿瘤未通过局部注射 MTX 消退（88%的治愈率）。未消退的肿瘤采用手术切除，无复发或并发症。在所有 9 例中，MTX 治疗后未消退的肿瘤大小相同或更小。73 个接受 MTX 治疗的肿瘤中，29 个肿瘤（11 例患者）为多发性 KA。所有 29 个肿瘤均消退（100%的肿瘤清除率）。接受 MTX 治疗的患者均无并发症。肿瘤清除定义为临床缓解至少 6 周且无复发。84 个肿瘤（83 例患者）采用手术切除治疗。手术无并发症，无复发（治愈率为 100%）。
对于单发 KA、多发 KA 或不适合手术的患者，局部注射 MTX 可作为初始治疗选择。
