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Keratoacanthoma — SCE Medical Oncology MCQ

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ModerateMelanoma & SkinKeratoacanthomaSCE Medical Oncology

A 70-year-old man presents with a rapidly growing skin tumour on his forearm that arose over 6 weeks. Biopsy shows a well-differentiated squamous proliferation with a central keratin-filled crater. The pathologist suggests keratoacanthoma vs well-differentiated SCC. What is the recommended management?

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Correct answer: A — Excision — keratoacanthoma and well-differentiated SCC cannot be reliably distinguished histologically; excision is recommended for diagnostic certainty and treatment

Keratoacanthomas (KA) and well-differentiated cutaneous SCCs are histologically difficult to distinguish, and some pathologists consider KA a variant of SCC. While KAs can spontaneously regress, this is unpredictable and some will behave as invasive SCCs. Excision is recommended for: diagnostic certainty, definitive treatment, and margin assessment. Alternatives for non-surgical candidates include radiotherapy or intralesional methotrexate. In the context of BRAF inhibitor therapy, KAs are common (paradoxical MAPK activation).

Reference: NICE Skin cancer guidelines; BAD SCC Guidelines; ESMO Non-melanoma Skin Cancer