Multiple Keratoacanthomas, Ferguson-Smith Variant

Jordan J. Miller, MD

Disclosures

December 23, 2009

History and Clinical Presentation

A 52-year-old man presented with multiple pruritic papules and nodules on his arms that had been present for the last 2 years. The patient denied spontaneous resolution of any individual lesion, and he had continued to develop new lesions. The patient did not have a personal or family history of keratoacanthoma (KA), colon cancer, or other cutaneous neoplasms. He denied weight loss, blood in the stools, or changes in his bowel habits.

Physical Examination

There were approximately 40 firm, 1- to 2-cm, dome-shaped, red- to flesh-colored, hyperkeratotic nodules on the lateral upper arm and extensor forearms (Figure 1). Most lesions had a central keratin plug (Figure 2).There were no smaller miliary papules. The central face and oral and ocular mucosa were normal.

Figure 1.

The patient had approximately 40 firm, 1- to 2-cm, dome-shaped, red-to-flesh colored, hyperkeratotic nodules on the lateral upper arm and extensor forearms.

Figure 2.

Most lesions had a central keratin plug.

Histopathology

A keratin-filled crater with overhung tongues of epithelium on either side was visualized on low power (Figure 3).The epithelium beneath the crater was composed of broad lobules of keratinocytes with small, regular nuclei and voluminous, glassy cytoplasms.

Figure 3.

On low power, a keratin-filled crater with overhung tongues of epithelium on either side was visualized. The epithelium beneath the crater was composed of broad lobules of keratinocytes with small, regular nuclei and voluminous, glassy cytoplasms.

Further Testing

Colonoscopy was performed, and there was no evidence of colonic pathology.

Diagnosis

Given the clinical and histologic findings and the absence gastrointestinal pathology, the diagnosis of multiple KAs, Ferguson-Smith variant, was made.

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