title: Persistent keratoacanthoma: challenges in management.
abstract: BACKGROUND
  Keratoacanthoma is a common cutaneous neoplasm, although the persistent form is less common and often more difficult to manage. Multiple treatment approaches have been attempted with variable efficacy. Establishing the diagnosis and selecting a treatment plan for persistent keratoacanthoma is often challenging.
  
  
  OBJECTIVE
  Our purpose is to describe the difficulty one may encounter in the diagnosis and treatment of persistent keratoacanthoma. Hopefully, review of this clinical conundrum may facilitate the management of the reader's future patients.
  
  
  METHODS
  We describe a case of persistent keratoacanthoma where the diagnosis was initially elusive and the management challenging. Our thought process during each stage of diagnosis and management is described in the form of "issues" with references to the appropriate literature.
  
  
  RESULTS
  After several diagnostic and therapeutic interventions, successful treatment was achieved with administration of oral isotretinoin. Long-term remission continued as the dosage was tapered.
  
  
  CONCLUSIONS
  Persistent keratoacanthoma may be challenging to diagnose and manage, presenting a clinical conundrum. Careful review of the clinicopathologic presentation and an understanding of the various treatment options may result in a successful outcome.
authors.affiliation: Department of Dermatology, University of Iowa Hospitals, Iowa City 52242.
authors.forename: G C
authors.initials: GC
authors.lastname: Canas
authors.forename: K J
authors.initials: KJ
authors.lastname: Robson
authors.forename: C J
authors.initials: CJ
authors.lastname: Arpey
mesh_terms: D000284:Administration, Oral; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D062109:Dermatologic Surgical Procedures; D006801:Humans; D015474:Isotretinoin / Q000008:administration & dosage; D007636:Keratoacanthoma / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D015474:Isotretinoin