Persistent keratoacantoma: Challenges in management

BACKGROUND. Keratoacanthoma is a common cutaneous neoplasm, although the pe rsistent form is less common and often more difficult to manage. Multiple t reatment approaches have been attempted with variable efficacy. Establishin g the diagnosis and selecting a treatment plan for persistent keratoacantho ma is often challenging. OBJECTIVE. Our purpose is to describe Nle difficulty one may encounter in t he diagnosis and treatment of persistent keratoacanthoma. Hopefully, review of this clinical conundrum may facilitate the management of the reader's f uture patients. METHODS. We describe a case of persistent keratoacanthoma where the diagnos is was initially elusive and the management challenging. Our thought proces s during each stage of diagnosis and management is described in the form of "issues" with references to the appropriate literature. RESULTS. After several diagnostic and therapeutic interventions, successful treatment was achieved with administration of oral isotretinoin. Long-term remission continued as the dosage was tapered. CONCLUSION. Persistent keratoacanthoma may be challenging to diagnose and m anage, presenting a clinical conundrum. Careful review of the clinicopathol ogic presentation and an understanding of the various treatment options may result in a successful outcome. (C) 1998 by the American Society for Derma tologic Surgery, Inc.