KERATOACANTHOMA



Serving Hamilton, Stoney Creek, Grimsby and surrounding areas.

Keratoacanthoma for Hamilton, Grimsby and Stoney Creek

General Information:

Keratoacanthoma

  • Is often mistaken as a boil or pimple initially.
  • It grows very rapidly, usually over a period of a few weeks.
  • Is a type of Squamous Cell Carcinoma.
  • Is a skin cancer of intermediate severity.
  • Does not spread internally.
  • Is not lethal.
  • Is caused by sun exposure many years before the cancer develops.

Prevention of Keratoacanthoma , and other skin cancers:

  • Wear a hat with a broad brim and protective clothing (e.g. long sleeves).
  • Avoid the outdoors when the sun is strongest between the hours of 10 am to 3 pm.
  • Use a sunscreen year round with an SPF of at least 30
  • Wear a sunscreen which resists water and sweating and which protects against both UVA and UVB.
  • Reapply sunscreen every hour if you are in water or sweating heavily.
  • Wear sunscreen even if you are in the shade, it is still possible to burn.
  • Avoid tanning beds. The ultraviolet light they produce causes skin cancer.

Levulan Photodynamic Therapy (ALA PDT) (Keratoacanthoma Prevention) :

  • This treatment combines a medication called Levulan with either Blue Light or IPL (Intense Pulsed Light) treatments.
  • Levulan PDT may be used to treat pre-cancerous sun spots or acne.  As such it can treat actinic keratoses which may turn into squamous cell carcinoma.
  • It is not powerful enough to treat a Keratoacanthoma once it has developed.
  • Unlike creams it has the advantage of being able to treat large areas in a single visit.
  • Unlike liquid nitrogen, the treatment is not painful.
  • As an added bonus, Levulan PDT treats precancerous spots before they can be seen, thus preventing skin cancer from developing
  • In addition , Levulan PDT also treats brown freckling, shrinks pores, improves sun damage and increases collagen in the skin.
  • All of these lead to smoother, younger looking skin and reduced redness at the same time.
  • The cost of Levulan PDT is partially covered on most private drug insurance plans.
  • The cost of Levulan PDT is not covered on the Ontario ODSP (OHIP) drug plan for patients over 65 years of age.

Treatment:

Electrodessication and Curettage (Most Keratoacanthomas):

  • This treatment is only most commonly for Keratoacanthomas.
  • The skin around the Keratoacanthoma is injected with a local anesthetic to numb the area.
  • The injection stings for a few seconds. After this, there is no pain or discomfort.
  • The Keratoacanthoma is removed from the skin in a scraping motion with an instrument called a curette.
  • As the area is numb from the anesthetic, this process is not painful.
  • The curetted area is then treated with electrocautery, a hot electric needle.  This is not painful as the area is still numb.
  • Electrocautery stops and bleeding and kills any residual cancer cells.
  • The lesion is scraped and cauterized a total of 3 times in one visit.
  • No stitches are required.
  • Antibiotic and a bandage are used to cover the wound.
  • The day after surgery, the bandage should be removed and a small amount of antibiotic should be be applied.  This should occur twice daily site is healed.
  • Redness, pain, swelling or a discharge from the wound may be a sign of infection.  The doctor should be informed immediately.
  • You may bathe, shower and do your normal activities unless the Keratoacanthoma that has been removed is very large and there is a risk of the wound being damaged. The doctor will inform you about this.
  • There is a small chance that the Keratoacanthoma could grow back.

Surgical Excision (All types of Keratoacanthoma):

  • The skin around the Keratoacanthoma is injected with a local anesthetic to numb the area.
  • The injection stings for a few seconds. After this, there is no pain or discomfort.
  • The Keratoacanthoma and a small amount of surrounding normal skin is cut with a scalpel and removed.
  • As the area is numb from the anesthetic, this process is not painful.
  • Stitches are used to close the opening.
  • Antibiotic and a bandage are used to cover the wound.
  • The day after surgery, the bandage should be removed and a small amount of antibiotic should be be applied.  This should occur twice daily until the stitches are removed.
  • Redness, pain, swelling or a discharge from the wound may be a sign of infection.  The doctor should be informed immediately.
  • The stitches are removed in 5 to 10 days.
  • The removal of stitches is painless.
  • You may bathe, shower and do your normal activities unless the Keratoacanthoma that has been removed is very large and there is a risk of the wound being damaged. The doctor will inform you about this.
  • There is a small chance that the Keratoacanthoma could grow back.

Radiation (All types of Keratoacanthoma):

  • This treatment is used very rarely.
  • To receive radiotherapy of a Keratoacanthoma , the lesion must be biopsied first.
  • To do the biopsy:

    • The skin around the Keratoacanthoma is injected with a local anesthetic to numb the area.
    • The injection stings for a few seconds. After this, there is no pain or discomfort.
    • A small portion of the Keratoacanthoma is removed.
    • As the area is numb from the anesthetic, this process is not painful.
    • Stitches are usually not necessary to close the opening.
    • The biopsied area is then treated with electrocautery, a hot electric needle.  This is not painful as the area is still numb.
    • The electrocautery is used to stop any bleeding.
    • Antibiotic and a bandage are used to cover the wound.
    • The day after surgery, the bandage should be removed and a small amount of antibiotic should be be applied for 1 week.
    • Redness, pain, swelling or a discharge from the wound may be a sign of infection.  The doctor should be informed immediately.
    • If stitches were used, they are removed in 5 to 10 days.
    • The removal of stitches is painless.
    • You may bathe, shower and do your normal activities after the biopsy.
  • Once the biopsy result is available the doctor will make a referral to a radiation specialist.
  • In Hamilton the radiation treatments and specialists are located at the Juravinski Cancer Centre next to the Henderson General Hospital.
  • The first visit with the radiation specialist if for an assessment only.
  • If he or she agrees with your doctor that the lesion is suitable for radiation, treatments will be arranged.
  • A large keratoacanthoma may require 10 to 15 treatments.  These are done daily, Monday to Friday over a period of 2 to 3 weeks.
  • After the radiation is complete, the spot will become red, scabby and crusted.
  • This will heal over the next few weeks.
  • There is a small chance that the Keratoacanthoma could grow back.

Mohs Micrographic Surgery (Complicated Keratoacanthoma) :

  • Mohs micrographic surgery is a detailed surgical procedure to treat aggressive non-melanoma skin cancers, mainly on the face and neck.
  • This treatment is usually reserved for the most complicated cases.
  • For appropriate patients in the Hamilton area, they are referred to the Mohs Centre at Women's College Hospital in Toronto.
  • Initially, the diagnosis must been confirmed with a biopsy (see above), prior to the referral being made.


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