Dermatologic Surgery
Intralesional methotrexate treatment for keratoacanthoma tumors: A retrospective study and review of the literature

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Background

Intralesional methotrexate (MTX) is an effective treatment for keratoacanthoma (KA).

Objective

We sought to systematically examine response rates and adverse events in KA treated with intralesional MTX.

Methods

All cases of KA treated with intralesional MTX at our institution from 1991 to 2006 were identified. A MEDLINE and PubMed search of cases of KA treated with intralesional MTX was also performed.

Results

In all, 38 cases of KA treated with intralesional MTX were identified: 18 from our institution and 20 from the literature. Intralesional MTX achieved resolution in 92%, requiring an average of 2.1 injections an average of 18 days apart. Adverse events were rare, with two reports of pancytopenia in patients with chronic renal failure.

Limitations

Use of single case reports, small series, and retrospective analysis are limitations.

Conclusion

Intralesional MTX is a useful nonsurgical therapy for the treatment of KA. Histologic diagnosis before initiation of treatment is preferred. A complete blood cell count at baseline and during treatment should be considered to monitor for potential cytopenia.

Section snippets

Methods

After institutional review board approval, patient data at a hospital-based public university from 1991 to 2006 were retrospectively examined. Eighteen cases of KA injected with intralesional MTX were identified at our institution. Our standard practice for injection is as follows: using a 30-gauge needle, 0.3 to 2.0 mL of MTX in a concentration of either 12.5 or 25 mg/mL is injected at each treatment session. Small KAs are injected at a single central point at the base of the lesion whereas

Results

In all, 38 cases of KA treated with intralesional MTX were identified: 20 cases from the published literature and 18 cases from our institution (Table I). At our institution, 18 patients with an average age of 72.5 years and an average tumor diameter of 2.1 cm were treated with 1 to 3 total injection sessions (mean 2.0 injection sessions). The average cumulative dose of intralesional MTX was 38.2 mg with injections spaced 12 to 38 days (mean 22 days) apart. A complete response was achieved in

Discussion

MTX has an appealing mechanism of action for the potential treatment of rapidly growing tumors, as it inhibits DNA synthesis in actively dividing cells. A folic acid analog, MTX irreversibly binds to dihydrofolate reductase, thereby blocking the formation of tetrahydrofolate and subsequently preventing the downstream synthesis of the purine nucleotide thymidine.25

In our pooled analysis of intralesional MTX for the treatment of KA, none of the patients treated experienced clinically apparent

References (27)

  • W.Y. Wong et al.

    Treatment of a recurrent keratoacanthoma with oral isotretinoin

    Int J Dermatol

    (1994)
  • H. Goldschmidt et al.

    Radiation therapy of giant aggressive keratoacanthomas

    Arch Dermatol

    (1993)
  • F. Reymann

    Treatment of keratoacanthomas with curettage

    Dermatologica

    (1997)
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      Methotrexate is a folic-acid analog that irreversibly inhibits the enzyme dihydrofolate reductase, blocking the synthesis of tetrahydrofolate and, ultimately, preventing the formation of thymidine9; likewise, it increases WWOX gene expression, which promotes caspase activation and apoptosis of cSCC cells.7 Many cases and series have reported on its effectiveness in treating keratoacanthoma10; however, data on intralesional methotrexate in patients with cSCC are scarce.7,11 Recently, a small observational retrospective trial comparing intralesional methotrexate plus surgery versus surgery alone demonstrated a reduction in tumor size that subsequently could facilitate surgery.7

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    Funding sources: None.

    Conflicts of interest: None declared.

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