Keratoacanthoma is a special type of tumor that affects the epithelium of the skin. Keratoacanthoma spontaneously regresses in some cases. The origin of the tumor is in the cells of the hair follicle.
What is a keratoacanthoma?
A keratoacanthoma is benign in the majority of cases. The tumor usually grows relatively quickly, although there is a possibility of spontaneous regression. There has been disagreement in medical research as to whether keratoacanthoma may represent a special form of squamous cell carcinoma. In this case, it would be a squamous cell carcinoma with particularly good chances of cure. However, the criteria for differentiating the two diseases are not very clear, so that an exact diagnosis is not possible in every case. Basically, keratoacanthomas occur mainly in older people. Especially often they appear in people older than 60 years. Thereby, male persons suffer from keratoacanthomas more often than female persons.
Causes
According to the current state of knowledge of medical research, the exact causes for the development of keratoacanthoma have not yet been conclusively clarified. However, it is suspected that excessive irradiation of the skin with UV light plays a role in the formation of the tumor. In addition, a connection to infection with HPV has been shown in individual cases. In principle, keratoacanthomas form in the majority of cases at an advanced age. Thereby, they mostly develop on such skin areas that are exposed to intensive solar radiation.
Symptoms, complaints, and signs
Keratoacanthomas are accompanied by various typical signs and symptoms. Basically, the tumor grows in the form of a nodule. In this case, it originates from the so-called keratinocytes, which are located in the funnel of the hair follicle. In its center, a horny cone is formed, which is also called a keratotic plug. Around this cone there is epithelial tissue that surrounds the plug from all sides. In principle, a keratoacanthoma exhibits a relatively high rate of growth. The tumor typically presents in the shape of a hemisphere. In some cases, depressions or telangiectasias form in its center. In this regard, in the majority of cases, keratoacanthoma develops on areas of the skin that are highly exposed to the sun, such as the face, forearms, and hands, as well as the neck area.
Diagnosis and course of the disease
Various examination methods are used to diagnose keratoacanthoma. In principle, even minor signs of keratoacanthoma give reason to consult an appropriate physician. This is because a timely diagnosis and subsequent treatment have a positive effect on the course of the disease. In the first step, the attending physician analyzes the patient’s medical history in a discussion with the patient concerned, which is also referred to as anamnesis. The focus is on previous illnesses, genetic predispositions and lifestyle characteristics. Clinical examinations are then performed. Histopathological methods in particular play an important role here. In histopathology, keratoacanthomas show a similar appearance to squamous cell carcinomas. For this reason, many physicians classify keratoacanthomas as a more harmless form of squamous cell carcinoma. However, the histological findings of the individual sections of the tumor sometimes differ greatly. Therefore, it is necessary to histologically examine and image the complete tumor. Microscopic examination reveals a crater with a keratinized plug. This plug is enclosed by so-called spiny cells, which may produce horny beads. Inflammatory substances are detectable in the dermis. In terms of differential diagnosis, spinaliomas, basaliomas, and actinic keratosis are relevant.
Complications
Keratoacanthoma usually presents with the usual symptoms and risks associated with cancer. In many cases, these tumors may also regress spontaneously, eliminating the need for treatment by a physician. The patients suffer from the growth of nodes. These nodes can also significantly reduce the aesthetics of the patient and thus limit the quality of life of the affected person. It is also not uncommon for depression or other psychological complaints to occur.Furthermore, many affected persons suffer from inferiority complexes or reduced self-esteem. Increased exposure to sunlight can also cause severe discomfort to the skin, so that the affected person usually has to protect himself from direct sunlight. Should the keratoacanthoma regress on its own, no further complications will occur. Life expectancy is also not reduced. However, surgical interventions may be necessary to surgically remove the keratoacanthoma. Again, there are usually no further complications. Only rarely do scars form. Affected persons should pay particular attention to sufficient sun protection.
When should one go to the doctor?
Changes in the appearance of the skin should always be examined and clarified by a doctor. There may be serious diseases that can lead to a fatal course without treatment. If lumps or swellings form on the skin, this is considered a warning sign from the organism that should be followed up. If existing symptoms increase in intensity or spread further, a doctor must be consulted. In case of keratoacanthoma, horny cones develop on the skin, which should be medically examined. Although spontaneous healing may occur with the disease, a visit to the doctor must be made at the first signs. The risk of the existing skin tumors mutating and taking a malignant course is too great. Often, the skin abnormalities appear on the face, forearms or in the neck area. If the visual blemish appears, a check-up visit to a doctor is advisable. If, in addition to the physical changes, there are also mental or emotional irregularities, a doctor is also needed. In the case of anxiety, behavioral abnormalities, a persistent depressed mood, or obsessive-compulsive behavior, consultation with a therapist or psychologically trained physician is recommended. The symptoms, if manifest, can lead to a mental disorder that further severely affects the overall well-being of the individual.
Treatment and therapy
As part of the therapy of keratoacanthomas, their removal is the main focus. This is because keratoacanthomas can hardly be differentiated externally from squamous cell carcinomas as well as some types of basal cell carcinoma. However, since some of these are malignant diseases, keratoacanthomas are also removed quickly in the majority of cases. It is true that keratoacanthomas are capable of spontaneous regression. Nevertheless, the risk of malignant change or confusion of the tumor with another disease is often not taken. This is because keratoacanthoma can hardly be accurately differentiated from certain forms of squamous cell carcinoma. In addition, there is a risk that the tumor may develop malignantly. After removal of the keratoacanthoma, the tissue is examined histopathologically. If a keratoacanthoma is removed from the face or inside the nose, the so-called Mohs surgery is usually used. This is a special technique in which very little tissue is lost or damaged. The edge of the incision is carefully controlled.
Outlook and prognosis
The prognosis of keratoacanthoma should be assessed according to individual circumstances. In most cases, it is positive. There are documented cases in which spontaneous healing has been reported. This may be temporary or permanent. Nevertheless, the disease must be differentiated from serious health developments. There is a possibility that the tumor may show malignant growth and thus endanger the life of the affected person. Therefore, to avoid risks, removal of the keratoacanthoma is often performed at an early stage. If the procedure proceeds without further complications, recovery subsequently occurs. In case of an advanced stage of the disease and a malignant course of the disease, cancer therapy is applied. This is associated with various risks and side effects. The quality of life of the affected person is impaired and there is also an increased risk of suffering a psychological sequelae. Since this is protracted and has a significant impact on the well-being of the affected person, the occurrence of a secondary disease must be taken into account in the position of the overall prognosis. Despite recovery, the disease may re-emerge at any time in the course of life.The prognosis remains positive in case of recurrence if treated early. Without therapy or medical clarification, the likelihood of malignant disease progression increases.
Prevention
Since the exact causes for the development of keratoacanthomas have not been completely clarified according to the current state of medical research, no exact statements about effective measures for the prevention of the tumors are possible so far. However, a large number of studies indicate that excessive exposure of the skin to sunlight promotes the formation of keratoacanthomas. For this reason, appropriate protection of the skin from the sun in the form of textiles and sunscreens may represent an approach to the prevention of keratoacanthomas. In addition, it is important to consult a physician when signs of keratoacanthoma are detected in order to initiate appropriate treatment.
Follow-up
In the case of keratoacanthoma, the first priority should be early diagnosis to avoid further complications and worsening of symptoms. In many cases, the measures and options for follow-up care are severely limited in this disease, so the focus is on early diagnosis to prevent further spread of the tumor. Self-healing usually cannot occur with keratoacanthoma. The symptoms are usually alleviated by surgical intervention, although the affected person should in any case rest and take it easy after such an intervention. The patient should refrain from strenuous or physical activities in order to avoid unnecessary strain on the body. The wound should be particularly well protected to prevent infection or inflammation. Furthermore, keratoacanthoma can lead to severe aesthetic discomfort, so that many patients also depend on psychological support. Especially loving and empathetic conversations with one’s own family or close friends have a positive effect on the course of the disease. In rare cases, keratoacanthoma also limits the life expectancy of the affected person.
What you can do yourself
In some cases, a keratoacanthoma will regress on its own. If this is not the case, the tumor must be surgically removed. Individual symptoms are usually relieved using conservative measures such as drug treatment. Patients can take some accompanying measures to speed up the healing process and avoid serious complications. First of all, the area around the tumor must be closely monitored in order to quickly detect any growth. In addition, a doctor must be consulted regularly to ensure that the keratoacanthoma does not metastasize. Should pain occur, those affected can resort to some remedies from homeopathy. For example, the pain-relieving belladonna and the anti-inflammatory arnica, which can be taken in the form of tablets or applied as ointments and lotions, have proven effective. Strict hygiene measures apply after a surgical procedure. The surgical wound must be well cared for to prevent infection and other complications. Accompanying this, the patient should take it easy for a few days and consult the doctor regularly. In the best case, the wound will heal without further discomfort and no new tumors will form.
