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August 1987

Squamous Cell Carcinoma Following Fluorouracil-Responsive `Keratoacanthoma'

Author Affiliations

Departments of Dermatology and Clinical Investigation Naval Hospital San Diego, CA 92134

Arch Dermatol. 1987;123(8):987-988. doi:10.1001/archderm.1987.01660320027002

To the Editor.—  The treatment of keratoacanthoma (KA) with fluorouracil cream administered by the intralesional1,2 and topical routes at concentrations of 20%3 and 5%4,5 has been reported. When treating these lesions without histologic confirmation, the following criteria are suggested to preclude the misdiagnosis of squamous cell carcinoma: (1) characteristic morphology of the keratoacanthoma, (2) history of growth of the lesion to its ultimate size within four to six weeks, and (3) prompt response of the lesion to fluorouracil treatment with at least 60% to 70% involution during a two-week treatment period.4 We describe a patient with such a lesion that initially responded to fluorouracil therapy only to recur three weeks after completion of therapy. An excisional biopsy specimen at that time revealed a poorly differentiated squamous cell carcinoma.

Report of a Case.—  A 76-year-old man presented with a three- to four-week history of a rapidly growing

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