Eruptive squamous atypia (also known as eruptive keratoacanthoma): Definition of the disease entity and successful management via intralesional 5-fluorouracil

Syril Keena Que, Leigh A. Compton, Chrysalyne D. Schmults

Research output: Contribution to journalArticle

Abstract

Background: Eruptive squamous atypia (ESA), which is an idiopathic, sometimes koebnerizing, proliferation of atypical but well-differentiated keratinocytes (also termed eruptive keratoacanthoma), is often misdiagnosed as cancer and managed by excisional surgery, provoking further koebnerization. A clear definition of this phenomenon and treatment outcome data are lacking. Objective: To define ESA and evaluate efficacy of intralesional (IL) 5-fluorouracil (5-FU) treatment. Methods: A retrospective cohort study examined patients with ESA that arose spontaneously or within a recent surgical scar and was treated with IL 5-FU at a tertiary academic center between January 2008 and December 2016. Complete clearance, partial clearance, and number of surgical excisions performed were tabulated. Results: Of 30 patients with 136 ESA lesions, 20 (67%) had resolution of ESA with IL 5-FU monotherapy. In all, 10 patients (33%) required additional therapy (topical 5-FU, steroids, cryotherapy, or acitretin). No IL 5-FU–treated ESA lesions required surgical excision. The number of excisional procedures decreased significantly (P = .006), with 27 patients (90%) needing fewer excisions 12 months after versus 12 months before initiation of IL 5-FU therapy. Dyspigmentation was the only adverse event. Limitations: Limitations include retrospective analysis and use of data from a single institution. Conclusion: With close clinical monitoring, IL 5-FU can be used to successfully treat ESA.

Original languageEnglish (US)
JournalJournal of the American Academy of Dermatology
DOIs
StatePublished - Jan 1 2019

Keywords

  • atypical squamous proliferation
  • eruptive keratoacanthoma
  • eruptive squamous atypia
  • hypertrophic lichen planus-like reactions
  • infundibulocystic hyperplasia
  • intralesional 5-flourouracil
  • postsurgical koebnerization
  • pseudoepitheliomatous hyperplasia
  • squamous cell carcinoma
  • squamous dysplasia
  • squamous proliferation

ASJC Scopus subject areas

  • Dermatology

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