Oculoplastics

CHAPTER

Eyelid Neoplasms 3

KERATOACANTHOMA K eratoacanthoma presents as an isolated lesion on the face with a unique appear ance. The lesion is dome shaped with a cen tral keratin-filled crater. It grows rapidly over weeks and may undergo spontaneous regres sion over months. Once considered benign, this is now considered a low-grade squamous carcinoma by most pathologists. Epidemiology and Etiology ● Age: Most often older than 50 years; rarely younger than 20 years ● Gender: More common in males than in females by a ratio of 2 to 1 ● Etiology: Unknown; ultraviolet radiation and chemical carcinogens may have a caus ative role. It is believed to originate from the pilosebaceous unit. History ● Rapid onset of growth over a few weeks ● The lesion is often asymptomatic except for cosmetic changes.

● There may be occasional tenderness. Examination ● Single, dome-shaped nodule with a central keratotic plug ● The lesion is firm and is slightly red to light brown in color ( Fig. 3-1 ). Special Considerations ● Once considered a benign lesion, there may still be some confusion in the liter ature about whether this is a squamous carcinoma. ● The lesion must be treated as a low-grade squamous carcinoma. Differential Diagnosis ● Basal cell carcinoma ● Hyperkeratotic actinic keratosis ● Squamous carcinoma Laboratory Tests ● Histopathology of the excised lesion ● Should be excised with frozen section guid ance or with Mohs surgery

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