TY - JOUR
T1 - Eruptive squamous atypia (also known as eruptive keratoacanthoma)
T2 - Definition of the disease entity and successful management via intralesional 5-fluorouracil
AU - Que, Syril Keena T.
AU - Compton, Leigh A.
AU - Schmults, Chrysalyne D.
N1 - Publisher Copyright:
© 2018 American Academy of Dermatology, Inc.
PY - 2019/7
Y1 - 2019/7
N2 - 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.
AB - 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.
KW - atypical squamous proliferation
KW - eruptive keratoacanthoma
KW - eruptive squamous atypia
KW - hypertrophic lichen planus-like reactions
KW - infundibulocystic hyperplasia
KW - intralesional 5-flourouracil
KW - postsurgical koebnerization
KW - pseudoepitheliomatous hyperplasia
KW - squamous cell carcinoma
KW - squamous dysplasia
KW - squamous proliferation
UR - http://www.scopus.com/inward/record.url?scp=85065587809&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2018.10.014
DO - 10.1016/j.jaad.2018.10.014
M3 - Article
C2 - 31103317
AN - SCOPUS:85065587809
SN - 0190-9622
VL - 81
SP - 111
EP - 122
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 1
ER -