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By Gary F. Gregasavitch, DPM, and Stephen
M. Schleicher, MD
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CASE:
A 72-year-old woman developed a small, asymptomatic papule on her left arm several weeks ago. Since then, the papule has rapidly expanded in size. TodayŐs examination finds this 2-cm nodule with its raised, erythematous border and crusted center. Scattered actinic keratoses are noted on the patientŐs hands and face. Axillary lymph nodes are not detected. Her past medical history is positive for basal cell carcinoma affecting her forehead.
WHAT IS YOUR DIAGNOSIS?
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The lesion was removed by curettage, and biopsy confirmed a diagnosis of keratoacanthoma. This tumor, which is considered a variant of squamous cell carcinoma, is characterized by a rapid growth phase and the presence of a dome-shaped nodule with a central keratin plug or ulceration. Sun-exposed areas are most susceptible. Although many cases will spontaneously involute, there have been occasional reports of metastatic spread. For this reason, most clinicians recommend surgical removal or, when this is not feasible, radiation therapy. |
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Dr. Gregasavitch is enrolled in a joint
dermatology-podiatry fellowship under the auspices of the
DermDx Centers for Dermatology of Northeastern Pennsylvania,
headquartered in Hazelton, and St. LukeŐs Hospital in Allentown,
Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical
instructor of dermatology at the Philadelphia College of
Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania,
and at Arcadia University in Glenside, Pennsylvania. He is
also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 38(4):33, 2006
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