Saturday, April 29, 2006

Volcanic Eruption

The patient is an 88 yo woman who came as a "walk-in" today.
She said she had a "volcano erupt" on her leg two weeks ago.

The examination shows an alert actve 88 yo woman with Type II skin. She has a dome-shaped tumor on her right shin which measures 2.1 cm in diameter. It seems to have a collarette surrounding it. She has marked actinic damage.

The history suggests keratoacanthoma. Some dermatologists call this "Squamous Cell Carcinoma -- Keratoacanthoma type." I suspect this is a coding ploy to make them seem malignant.

My question is what to do?
1) It would be hard to close after excision in this site.
2) If it is curetted and dessicated, it make take weeks to months to heal.
3) It could be observed, however, some of these larger lesions can be locally agressive.
4) Intralesional methotrexate is a possibility.

My instinct is to treat with C and E, but I'd like some suggestions. I might follow that with Aldara. I am open to suggestions.

Thank you.

David Elpern

May 4, 2006
At the advice of a few of you, I did a shave biopsy and curetted and dessicated the lesion. The base was mostly gritty (a good sign). I will follow closely. She's 88 year-old. So, I'll observe before any further intervention. May try imiquimod. Will play by ear.


  1. Perhaps i'm not in my good mood these days, but i cannot see any cenrtal keratotic plug in the lesions you call a "volcano"!
    Anyway, my suggestions;
    1. A skin biopsy
    2. Intralesional MTX ( or 5-FU) with the hope of shrinking the lesion
    3. C&E which hopefully would be easier after volume reduction by 1 and 2.
    Cheers, Omid

  2. I can not say this is typical KA.Biopsy will not diffirentiate between SCC and KA as shouldring will not be noticed.Neotigason might be helpful.

    khalifa sharquie

  3. AnonymousMay 03, 2006

    Short history may favour KA while clinically does't.Biopsy is necessary to exclude others of a typical presentation for example appendegeal tumors like porocarcinoma.


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