Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Solitary Keratoacanthoma at the Recipient Site of a Full-Thickness Skin Graft: A Case Report and Review of the Literature

  • Jeong Ho Kim (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine) ;
  • Sang-Hoon Lee (Department of Dermatology, Yonsei University Wonju College of Medicine) ;
  • Seung-Phil Hong (Department of Dermatology, Yonsei University Wonju College of Medicine) ;
  • Jiye Kim (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine) ;
  • Sug Won Kim (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine)
  • Received : 2022.05.27
  • Accepted : 2022.11.01
  • Published : 2023.01.15
Download PDF
⟨ Previous Next ⟩

Abstract

A 57-year-old man presented with a pigmented papule, 0.4 cm in diameter, on the left lower eyelid. Skin biopsy revealed a basal cell carcinoma, which was excised through a wide excision followed by a full-thickness skin graft (FTSG). Two weeks after the surgery, an erythematous nodule developed in the lower margin of the graft recipient site. The nodule size increased rapidly over 2 weeks, becoming dome-shaped with a central hyperkeratotic plug. A diagnosis of keratoacanthoma (KA) was made, and surgical excision was performed. Histological findings revealed a large, well-differentiated squamous tumor with a central keratin-filled crater and buttress. The human papilloma virus (HPV) genotyping results were negative. Risk factors for KA include trauma, old age, exposure to ultraviolet (UV) radiation, immunosuppression, and HPV infection. KA has most often been reported to develop at the donor site. Although the pathogenesis of KA is unclear, trauma is believed to act as a second insult to a preceding oncogenic insult, such as exposure to UV radiation, resulting in a koebnerization. Herein, we report a case of solitary KA at a FTSG recipient site. This report presents information that may provide guidance during dermatologic surgeries.

Keywords

Acknowledgement

We are indebted to the generous patient who made this report possible. Informed consent was obtained for the publication of this case report.

References

  1. Rook A, Whimster I. Kerato-acanthoma. Arch Belg Dermatol Syphiligr 1950;6(03):137-146
  2. Tisack A, Fotouhi A, Fidai C, Friedman BJ, Ozog D, Veenstra J. A clinical and biological review of keratoacanthoma. Br J Dermatol 2021;185(03):487-498 https://doi.org/10.1111/bjd.20389
  3. Elder De MD, Scolyer RA, Willemze R. WHO Classification of Skin Tumours. Lyon: International Agency for Research on Cancer; 2018
  4. Kwiek B, Schwartz RA. Keratoacanthoma (KA): an update and review. J Am Acad Dermatol 2016;74(06):1220-1233 https://doi.org/10.1016/j.jaad.2015.11.033
  5. Dibden FA, Fowler M. The multiple growth of molluscum sebaceum in donor and recipient sites of skin graft. Aust N Z J Surg 1955;25(02):157-159 https://doi.org/10.1111/j.1445-2197.1955.tb05122.x
  6. Pattee SF, Silvis NG. Keratoacanthoma developing in sites of previous trauma: a report of two cases and review of the literature. J Am Acad Dermatol 2003;48(2, Suppl):S35-S38 https://doi.org/10.1067/mjd.2003.114
  7. Nagase K, Suzuki Y, Misago N, Narisawa Y. Acute development of keratoacanthoma at a full-thickness skin graft donor site shortly after surgery. J Dermatol 2016;43(10):1232-1233 https://doi.org/10.1111/1346-8138.13368
  8. Taylor CD, Snelling CF, Nickerson D, Trotter MJ. Acute development of invasive squamous cell carcinoma in a split-thickness skin graft donor site. J Burn Care Rehabil 1998 Sep-Oct;19(05):382-385 https://doi.org/10.1097/00004630-199809000-00004
  9. Vergara A, Isarria MJ, Dominguez JD, Gamo R, Rodriguez Peralto JL, Guerra A. Multiple and relapsing keratoacanthomas developing at the edge of the skin grafts site after surgery and after radiotherapy. Dermatol Surg 2007;33(08):994-996
  10. Nishibaba R, Higashi Y, Mera K, Kanekura T. Successful etretinate treatment of recurrent keratoacanthomas on a skin graft: case report. J Dermatol 2017;44(02):224-225 https://doi.org/10.1111/1346-8138.13464
  11. Lee S, Coutts I, Ryan A, Stavrakoglou A. Keratoacanthoma formation after skin grafting: a brief report and pathophysiological hypothesis. Australas J Dermatol 2017;58(03):e117-e119 https://doi.org/10.1111/ajd.12501
  12. Daniel D, Meyer-Morse N, Bergsland EK, Dehne K, Coussens LM, Hanahan D. Immune enhancement of skin carcinogenesis by CD4 + T cells. J Exp Med 2003;197(08):1017-1028 https://doi.org/10.1084/jem.20021047
  13. Sagi L, Trau H. The Koebner phenomenon. Clin Dermatol 2011;29(02):231-236 https://doi.org/10.1016/j.clindermatol.2010.09.014
  14. Wulsin JH. Keratoacanthoma: a benign cutaneous tumour arising in a skin graft donor site. Am Surg 1958;24:689-692
  15. Schwartz RA. Multiple persistent keratoacanthomas. Oncology (Basel) 1979;36:281-285 https://doi.org/10.1159/000225359
  16. Soto-de-Delas J, Leache A, Vasquez-Doval J, et al. Queratoacantoma sobre zona dadora de injerto laminar. Med Cutan Iberio Latin Am 1989;17:225-228
  17. Hamilton SA, Dickson WA, O'Brien CJ. Keratoacanthoma developing in a split skin graft donor site. Br J Plast Surg 1997;50;560-561 https://doi.org/10.1016/S0007-1226(97)91308-4
  18. Tamir G, Morgenstern S, Ben-Amitay D, Ben-Amitay D, Okon E, Hauben DJ. Synchronous appearance of keratoacanthomas in burn scar and skin graft donor site shortly after injury. J Am Acad Dermatol 1999;40:870-871 https://doi.org/10.1053/jd.1999.v40.a94419