Seger Edward W, Tarantino Isadore S, Neill Brett C, Wang Ting
Division of Dermatology, University of Kansas Medical Center, Kansas City, KS.
Dermatol Online J. 2020 Mar 15;26(3):13030/qt0g36s6sp.
Keratoacanthomas are rapidly growing neoplasms of squamous epithelium. Despite their benign nature, they are often difficult to distinguish from squamous cell carcinoma and require excision. In cases in which excision is not successful or not desired, intralesional treatments may be considered. However, limited research exists on individual therapeutic efficacy. We present a 68-year-old man who developed multiple eruptive keratoacanthomas around the wound edge of a previous keratoacanthoma excision. Considering previous excisional failure, intralesional 5-fluorouracil was used as a treatment modality. Injections every 3-4 weeks over a course of 12 weeks induced clinical keratoacanthoma clearance with excellent cosmetic results. This case showcases that weekly intralesional 5-fluorouracil injections, as was the standard mode of treatment in previous case reports, may not be necessary. This less frequent injection strategy is more convenient for the patient and may lead to fewer treatments and less medication necessary. Although a case-by-case basis is needed for any alternative approach to keratoacanthoma treatment, this report is useful for the practicing clinician in showing that 5-fluorouracil may be efficacious in these difficult-to-treat patients.
角化棘皮瘤是鳞状上皮的快速生长肿瘤。尽管其本质为良性，但通常难以与鳞状细胞癌区分开来，需要进行切除。在切除不成功或患者不希望切除的情况下，可以考虑病灶内治疗。然而，关于个体治疗效果的研究有限。我们报告了一名68岁男性，他在先前角化棘皮瘤切除伤口边缘出现了多发性暴发性角化棘皮瘤。考虑到先前切除失败，采用病灶内注射5-氟尿嘧啶作为治疗方式。在12周的疗程中，每3-4周注射一次，临床上角化棘皮瘤清除，美容效果极佳。该病例表明，先前病例报告中的标准治疗方式——每周病灶内注射5-氟尿嘧啶可能并非必要。这种注射频率较低的策略对患者来说更方便，可能需要的治疗次数更少，用药量也更少。尽管任何角化棘皮瘤治疗的替代方法都需要根据具体情况而定，但本报告对临床医生有用，表明5-氟尿嘧啶可能对这些难治性患者有效。
