Keratoacanthoma in a Patient With Skin of Color

Keratoacanthomas are rapidly growing, benign cutaneous neoplasms that can mimic squamous cell carcinoma, presenting diagnostic and management challenges for physicians. The case report investigates a 63-year-old African American female who presented to a family medicine clinic with a one-year history of a progressively enlarging nodule on her right shin. Clinical examination revealed a seven-millimeter dome-shaped, hyperpigmented, well-defined, scaly, rough papule with central umbilication and a keratin plug. Histopathological analysis of an excisional biopsy confirmed the diagnosis of keratoacanthoma with clear margins. Due to the significant overlay in gross appearance and dermoscopic features of keratoacanthomas and malignant squamous cell carcinomas, it is imperative to fully excise similarly presenting lesions and send them for microscopic analysis. Even with histologic examination, keratoacanthomas and squamous cell carcinomas can be challenging to differentiate. Therefore, the priority of contemporary research lies in new methods of distinguishing the two conditions so that the self-limited, benign keratoacanthoma can be managed more conservatively, avoiding invasive removal and associated morbidity. This scholarship is especially pertinent to patients, like the one in this case study, with skin of color who are more likely to experience post-operative complications such as proinflammatory hyperpigmentation, hypertrophic scars, and keloids, but are also at risk of squamous cell carcinoma.