Histology: The tumor is typically a cup-shaped exophytic nodule that has a prominent keratin-filled plug. The borders of the tumor are well circumscribed. The tumor is symmetric. Neutrophilic abscesses within the outer layers of the involved epidermis are a characteristic finding in keratoacanthomas. The keratinocytes that make up the bulk of the tumor have a glassy cytoplasm with large amounts of glycogen. Other unique findings in this tumor are the presence of plasma cells and eosinophils and the elimination of elastic fibers through the overlying epidermis.
Treatment: After a keratoacanthoma has been biopsied, the treatment of choice is surgical removal. This can be done with a standard elliptical excision or with Mohs micrographic surgery. Intralesional methotrexate and oral retinoids have been used in refractory cases and in individuals who cannot tolerate surgery. The familial forms of keratoacanthoma often require longterm retinoid therapy to keep the tumors at bay.
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