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Sir,
Keratoacanthoma (KA) is a cutaneous squamoproliferative tumor with the potential for spontaneous resolution and needs to be treated due to its resemblance to cutaneous squamous cell carcinoma. It is a unique, benign or borderline malignant neoplasm exhibiting follicular (infundibular/isthmic) differentiation characterized by the involvement of continuous follicular infundibula in multiples. Multiple self-healing squamous epithelioma of Ferguson-Smith (MSSE) is a rare autosomal dominantly inherited disease, almost exclusively reported in patients of Scottish origin, with recurrent, histologically malignant tumours that undergo spontaneous regression [
The initial lesions of MSSE are similar to KA and typically localized in light-exposed skin areas. They begin with an acne-like lesion or a reddish macule, developing into a papule and later a nodule with a central crateriform ulcer with rolled edges and often a central horny plug. The tumour is locally destructive and deep local infiltration can be seen. The growth phase is, after a few weeks, followed by spontaneous regression over a period of months leaving pitted scars [
The first-line therapy for KA that is simple and well tolerated is conventional surgical excision [
In patients with multiple self-healing squamous epithelioma (MSSE) or generalized eruptive keratoacanthoma of Grzybowsky, oral acitretin (25 to 60 mg per day) and isotretinoin (20 mg per day to 1.5 mg/kg per day) have been used. Other systemic therapies that have been used in a few patients with multiple KAs include methotrexate plus prednisone, cyclophosphamide and intravenous 5-FU. Serial zinc oxide wraps have been used.