Presentation Type
Poster
Discipline Track
Community/Public Health
Abstract Type
Case Report
Abstract
Background: Common cutaneous warts, referred to in medicine as verrucae vulgaris, are proliferative lesions caused by human papillomavirus. These lesions are mostly benign and usually resolve without incident, except in the case of the patient mentioned in this report. Our patient developed a solitary keratoacanthoma, currently accepted as a clinical variant of squamous cell carcinoma, as a result of several risk factors and traumatic exposure. The current literature does not have an established association of HPV with solitary keratoacanthomas. This case report explores the presentation and pathogenesis of solitary keratoacanthomas within the setting of HPV.
Case Presentation: 48-year-old Caucasian female presents to the family medicine clinic regarding a “bumpy lesion” on her right dorsal hand onset one month ago. She mentioned that she previously had a 5 mm wart in that location that was unchanged for several years. Two months ago, she “sprayed it with some Biofreeze spray” hoping that the wart would “dry up and fall off”. She reported that the spray caused burning pain and the wart formed a blister but did not fall off. Over the past month, she reported the wart transformed into the presenting lesion and added that she “bumped it a few times”, causing it to bleed and scab over. She admitted spending considerable time outdoors without adequate sunscreen use. Additional history included x-rays of right hand for history of right wrist carpal tunnel syndrome. She denied any pain to her right hand, wrist or fingers, pruritis, swelling, rash, sensory/motor/neurological changes. Physical exam revealed a 1 cm x 1 cm x 0.7 cm circular, crateriform nodular lesion on the dorsal surface of the third proximal metacarpal with a central keratinous filling and pink, indurated, hyperplastic borders. Evidence of solar lentigines noted on surrounding skin. Based on the presentation of the lesion, course of lesion progression, and associated history of the patient, a diagnosis of solitary keratoacanthoma was made. A shave biopsy was performed in the clinic, and the pathology report confirmed the diagnosis. However, the lesion demonstrated regrowth with a with continued pink, hyperplastic growth 1 cm x 1 cm and 0.3 cm above the skin surface. The patient was referred to dermatology for Moh’s procedure and further consultation.
Conclusion: This middle-aged, lightly-pigmented patient presented with a long-term cutaneous wart on a location previously exposed to radiation and chronic sun that underwent transformation into a solitary keratoacanthoma after being subjected to both mechanical and chemical trauma. This case is instanced as another example of keratoacanthomas occurring in the setting of HPV. A dual-insult driven etiology for the pathogenesis of sKA fits well in the context of our patient’s symptom presentation. It must be emphasized that the scope of skilled dermatologic intervention must be expanded to family medicine doctors and general practitioners, especially in underserved areas where specialties such as dermatology can be expensive with long wait times. Such interventions in the field of dermatology and oncology eliminate health disparity and adverse outcomes in our communities and promote overall health equity in the greater RGV.
Academic/Professional Position
Medical Student
Mentor/PI Department
Family Medicine
Recommended Citation
Ninan, Joshua M. and Salazar, Veronica, "Development of Solitary Keratoacanthoma from a Cutaneous Wart" (2024). Research Symposium. 25.
https://scholarworks.utrgv.edu/somrs/2024/posters/25
Included in
Biological Phenomena, Cell Phenomena, and Immunity Commons, Community Health and Preventive Medicine Commons, Dermatology Commons, Digestive, Oral, and Skin Physiology Commons, Family Medicine Commons, Infectious Disease Commons, Neoplasms Commons, Oncology Commons, Pathology Commons, Patient Safety Commons, Preventive Medicine Commons, Primary Care Commons, Public Health Education and Promotion Commons, Skin and Connective Tissue Diseases Commons, Virus Diseases Commons, Viruses Commons
Development of Solitary Keratoacanthoma from a Cutaneous Wart
Background: Common cutaneous warts, referred to in medicine as verrucae vulgaris, are proliferative lesions caused by human papillomavirus. These lesions are mostly benign and usually resolve without incident, except in the case of the patient mentioned in this report. Our patient developed a solitary keratoacanthoma, currently accepted as a clinical variant of squamous cell carcinoma, as a result of several risk factors and traumatic exposure. The current literature does not have an established association of HPV with solitary keratoacanthomas. This case report explores the presentation and pathogenesis of solitary keratoacanthomas within the setting of HPV.
Case Presentation: 48-year-old Caucasian female presents to the family medicine clinic regarding a “bumpy lesion” on her right dorsal hand onset one month ago. She mentioned that she previously had a 5 mm wart in that location that was unchanged for several years. Two months ago, she “sprayed it with some Biofreeze spray” hoping that the wart would “dry up and fall off”. She reported that the spray caused burning pain and the wart formed a blister but did not fall off. Over the past month, she reported the wart transformed into the presenting lesion and added that she “bumped it a few times”, causing it to bleed and scab over. She admitted spending considerable time outdoors without adequate sunscreen use. Additional history included x-rays of right hand for history of right wrist carpal tunnel syndrome. She denied any pain to her right hand, wrist or fingers, pruritis, swelling, rash, sensory/motor/neurological changes. Physical exam revealed a 1 cm x 1 cm x 0.7 cm circular, crateriform nodular lesion on the dorsal surface of the third proximal metacarpal with a central keratinous filling and pink, indurated, hyperplastic borders. Evidence of solar lentigines noted on surrounding skin. Based on the presentation of the lesion, course of lesion progression, and associated history of the patient, a diagnosis of solitary keratoacanthoma was made. A shave biopsy was performed in the clinic, and the pathology report confirmed the diagnosis. However, the lesion demonstrated regrowth with a with continued pink, hyperplastic growth 1 cm x 1 cm and 0.3 cm above the skin surface. The patient was referred to dermatology for Moh’s procedure and further consultation.
Conclusion: This middle-aged, lightly-pigmented patient presented with a long-term cutaneous wart on a location previously exposed to radiation and chronic sun that underwent transformation into a solitary keratoacanthoma after being subjected to both mechanical and chemical trauma. This case is instanced as another example of keratoacanthomas occurring in the setting of HPV. A dual-insult driven etiology for the pathogenesis of sKA fits well in the context of our patient’s symptom presentation. It must be emphasized that the scope of skilled dermatologic intervention must be expanded to family medicine doctors and general practitioners, especially in underserved areas where specialties such as dermatology can be expensive with long wait times. Such interventions in the field of dermatology and oncology eliminate health disparity and adverse outcomes in our communities and promote overall health equity in the greater RGV.