Keratoacanthoma Treatment When Surgery Is Not the Primary Option
When standard surgical excision is not appropriate — due to patient fitness, lesion location at a cosmetically sensitive site, or recurrence — non-surgical modalities can achieve complete clearance of the keratoacanthoma lesion.
Clinical Scenario
This protocol is indicated for patients with keratoacanthoma who are unfit for surgery, have lesions at cosmetically sensitive anatomical sites, or present with recurrent disease. It defines the appropriate non-surgical pathway for each situation.
Treatment Approach (Overview)
Several non-surgical modalities are employed, including physical therapies and topical or intralesional agents. The protocol specifies which modality is appropriate for which clinical situation — the complete selection criteria and sequencing are detailed in the full regimen below.
Treatment Goal
Complete resolution and clearance of the keratoacanthoma skin lesion.
References
DOI: 10.3390/ijms262010040
- Radiotherapy (RT) and cryotherapy are physical therapies for treating KAs.
- Although cryotherapy has not been widely studied as a therapeutic option, its effectiveness has been reported in about 87% of KAs.
- Photodynamic therapy (PDT) also belongs to the group of physical therapies.
- The argon lasers have also been used for KAs.
- Topical 5-fluorouracil (5-FU) and imiquimod represent two valuable alternatives for KAs.
- Indeed, the use of topical 5-FU led to a complete resolution of the lesion within six weeks in a retrospective analysis.
- 5-FU can also be used for intralesional applications.
- An average of three injections in three weeks has been reported as effective.
- However, imiquimod should be applied for 9–11 weeks, three to four times a week, to obtain a complete remission.
- Intralesional administration of MTX is considered another alternative to surgery.
- Furthermore, Annest et al. reported in a review that intralesional MTX achieved resolution in 92% of patients, requiring an average of two injections 18 days apart.
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