Keratoacanthoma centrifugum marginatum: unresponsive to oral retinoid and successfully treated with wide local excision.

Kapildev Das, Nilay Kanti Das, Vikram Singh Rathore, Sourav Kundu, Sourav Choudhury, Ramesh Chandra Gharami, Pijush Kanti Datta
  • Kapildev Das
    Department of Dermatology, Medical College & Hospital, Kolkata, India, India
  • Nilay Kanti Das
    Department of Dermatology, Medical College & Hospital, Kolkata, India, India | drdasnilay@gmail.com
  • Vikram Singh Rathore
    Department of Plastic Surgery, Medical College & Hospital, Kolkata, India,
  • Sourav Kundu
    Department of Dermatology, MGM Medical College, Kishangang, India, India
  • Sourav Choudhury
    ESI Hospital, Manicktala, Kolkata, India
  • Ramesh Chandra Gharami
    Department of Dermatology, Medical College& Hospital, Kolkata, India, India
  • Pijush Kanti Datta
    Department of Dermatology, Medical College& Hospital, Kolkata, India, India

Abstract

We describe a case of a 65-year-old male presenting with a large plaque with a rolled-out interrupted margin, atrophic center, and island of normal skin over the left arm. It grew peripherally with central healing, and there was a history of recurrence after inadequate excision. Investigations ruled out other clin­ical mimickers; namely, squamous cell carcinoma, lupus vulgaris, botryomycosis, and blastomycosis-like pyoderma. Histopathological sections showed irregularly shaped craters filled with keratin and epithelial pearl but no evidence of granuloma or cellular atypia. Clinico­pathological correlation proved the lesion to be keratoacanthoma centrifugum marginatum (KCM), a rare variant of keratoacanthoma, which spreads centrifugally, attains a huge size, and never involutes spontaneously. Treatment of KCM has been a problem always and, in our case, systemic retinoid (acitretin for three months) proved ineffective. The patient also had a history of recurrence following surgical intervention previously, necessitating wide excision to achieve complete clearance of tumor cells. Hence, after failure of retinoid therapy, the decision of excision with a 1-centimeter margin was taken and the large defect was closed by a split thickness skin graft. The graft uptake was satisfactory, and the patient is being followed-up presently and shows no signs of recurrence after six months, highlighting wide local excision as a useful treatment option.

Keywords

Keratoacanthoma centrifugum marginatum; Retinoid; Local excision

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Submitted: 2009-07-14 00:10:16
Published: 2010-01-18 12:22:32
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Copyright (c) 2010 Kapildev Das, Nilay Kanti Das, Vikram Singh Rathore, Sourav Kundu, Sourav Choudhury, Ramesh Chandra Gharami, Pijush Kanti Datta

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