title: [Intralesional infusion of methotrexate as neoadjuvant therapy improves the cosmetic and functional results of surgery to treat keratoacanthoma: results of a randomized trial].
abstract: BACKGROUND
  Keratoacanthoma is currently considered to be an in situ squamous cell carcinoma that mainly affects patients over 70 years of age. The tumor has a good prognosis and, in some cases, can resolve spontaneously. Treatment involves simple excision. However, since the tumors generally occur on the face or extremities and display rapid growth, aggressive surgery may be required and the cosmetic results may be poor.
  
  
  OBJECTIVE
  The primary study objective was assessment of the efficacy of presurgical intralesional methotrexate infiltration to reduce the size of the tumor and the corresponding surgical defect.
  
  
  METHODS
  A prospective, randomized study was undertaken in patients with a diagnosis of keratoacanthoma of at least 1.5 cm who were seen in our service between January 2009 and January 2010. Two groups were established: one receiving a single infiltration of methotrexate prior to surgery and another that did not receive methotrexate.
  
  
  RESULTS
  Of the 25 patients included in the study, 10 received neoadjuvant intralesional methotrexate (group A) and 15 underwent surgery without prior infiltration of methotrexate (group B). The patients in group A displayed a reduction of between 50% and 80% in the size of the lesion prior to surgery. No complications were observed either in relation to methotrexate infusion or surgery. In group B, only 1 patient had a slight reduction in the dimensions of the lesion prior to surgery. In the remaining cases, the lesions remained similar (4 cases, 26%) or had increased in size (10 cases, 66%) at the time of surgery. Five patients in this group required hospital admission following surgery.
  
  
  CONCLUSIONS
  Neoadjuvant intralesional methotrexate is well tolerated and reduces the need for aggressive surgery in elderly patients with keratoacanthoma measuring more than 1.5 cm on the face or extremities.
authors: Departamento de Dermatología, Instituto Valenciano de Oncología, Valencia, España. antmarto@hotmail.com
authors: A
authors: A
authors: Martorell-Calatayud
authors: C
authors: C
authors: Requena
authors: E
authors: E
authors: Nagore
authors: O
authors: O
authors: Sanmartín
authors: C
authors: C
authors: Serra-Guillén
authors: R
authors: R
authors: Botella-Estrada
authors: V
authors: V
authors: Sanz-Motilva
authors: B
authors: B
authors: Llombart
authors: A
authors: A
authors: Alcañiz-Moscardo
authors: C
authors: C
authors: Guillén-Barona
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004954:Esthetics; D005153:Facial Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D005260:Female; D006225:Hand; D006801:Humans; D015552:Injections, Intralesional; D007636:Keratoacanthoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate