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

  • Kapildev Das Department of Dermatology, Medical College & Hospital, Kolkata, India, India.
  • Nilay Kanti Das | drdasnilay@gmail.com Department of Dermatology, Medical College & Hospital, Kolkata, India, India.
  • 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.

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Author Biography

Nilay Kanti Das, Department of Dermatology, Medical College & Hospital, Kolkata, India

Assistant Professor

Department of Dermatology,

Medical College & Hospital, Kolkata

88, College Street, Kolkata 73

India

Published
2010-01-18
Section
Articles
Keywords:
Keratoacanthoma centrifugum marginatum, Retinoid, Local excision
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How to Cite
Das, K., Das, N., Rathore, V., Kundu, S., Choudhury, S., Gharami, R., & Datta, P. (2010). Keratoacanthoma centrifugum marginatum: unresponsive to oral retinoid and successfully treated with wide local excision. Dermatology Reports, 2(1), e1. https://doi.org/10.4081/dr.2010.e1