Cutaan plaveiselcelcarcinoom na irradicale resectie van keratoacanthoom

Keratoacanthoma is a common cutaneous tumor, of
which the benign or malignant potential remains controversial.
Keratoacanthoma is often considered as a benign
skin tumor, because metastases rarely occur. However,
metastases of a keratoacanthoma are reported in literature.
Furthermore, development of squamous cell carcinoma
in keratoacanthoma is also reported. Besides this,
it can histopathologically be difficult or even impossible
to distinguish between a well differentiated squamous
cell carcinoma and keratoacanthoma. These factors lead
to complex therapeutical decisions, that can have large
implications for the patient.
In this report we present a case of an incompletely
excised moderately differentiated squamous cell carcinoma
of the left cheek (infraorbital), which was initially
diagnosed as keratoacanthoma at the referring hospital.
The patient was referred to our multidisciplinary head
and neck team. It was decided to perform a re-resection,
using a so-called ‘Slow Mohs’-procedure. This re-resection
appeared to be incomplete and showed extensive
perineural growth. This perineural growth extended
along the infraorbital/maxillary nerve via the foramen
rotundum, into the sinus cavernosus. This made radical
surgical resection impossible. It was decided to treat the
patient with adjuvant radiotherapy.
This case emphasizes not only the controversy surrounding
the benign or malignant nature of a keratoacanthoma
and the implications for the patient, but also the
importance of an adequate multidisciplinary approach in
such complex cases.