Keratoacanthoma (KA) is an epithelial tumor characterized by rapid, abundant growth and a potential for spontaneous resolution. It typically occurs on the skin in sun-exposed areas such as the face, neck, and hands. Rarely it can occur on the conjunctiva and vulvar region. Since the 1950s, there has been an ongoing debate whether KA is a distinct clinical entity or if it is a subtype of squamous cell carcinoma (SCC). Here we present a 36-year-old female who presents with a rapidly growing white lesion on her conjunctiva, who underwent an excisional biopsy, which showed squamous cell carcinoma, keratoacanthoma type.
This presentation focuses on the definition of keratoacanthoma, literature review on cases of conjunctival keratoacanthoma, diagnosis, and management. The natural history of conjunctival KA is obscure because they are excised early. It is unknown whether they regress like their cutaneous counterparts vs. invasive. Diagnostic modalities include clinical examination, anterior segment OCT, ultrasound biomicroscopy, impression cytology, confocal microscopy, but the gold standard is excisional biopsy. There has been controversy in the classification of keratoacanthoma; however, this may not have much significance in clinical practice, because the standard practice for treating KA, including other types of SCC, is usually a surgery irrespective of the classification. Our patient underwent wide surgical excision and sclerectomy with no touch technique, cryotherapy to the edges, and closure with amniotic membrane. One month after, repeat anterior segment OCT showed no new epithelial lesions and she was started on 5-fluorouracil for two cycles for chemoprevention.
Presentation Date: 02/15/2018
Issue Date: 08/01/2020