Fatma BİLGEN, Alper URAL, Mehmet BEKERECİOĞLU

A SHEEP IN WOLF’S CLOTHING, OR A WOLF IN SHEEP’S CLOTHING? KERATOACHANTOMA

A Keratoacanthoma is a dome-shaped, pink-colored benign skin tumor, around 1–2 cm in height with a central crater filled withkeratinous plaque, that is assumed to be caused by the exposure of hair follicles to sunlight. The most prominent discussion onKeratoacanthoma is whether it is malignant or benign, and this discussion is challenging for a clinician and absorbing for a researcher,asit can play a key role in understanding cancer regression. Keratoacanthomas resemble squamous cell carcinomas, both clinically andhistologically and in the resulting confusion, Keratoacanthoma can be defined as a sheep in wolf’s clothing, but can also be regarded asthe wolf in the sheep’s clothing, as there is an emerging view that it could be the precursor to squamous cell carcinomas. A total orpartial excision of the biopsy material, including subcutaneous fat tissue, or a fusiform partial excision, including the center and bothsides along the entire course of the lesion, to represent the whole lesion. In addition, the excised biopsy material should include at least2 mm of intact skin on both sides.

Kurt Postunda Koyun mu veya Koyun Postunda Kurt mu? Keratoakantom

Keratoakantom, ciltten 1-2 cm yükseklikte, kubbe şeklinde, santral bölgede keratinöz plak ile dolu krateri olan pembe renkli benign bir cilt tümörü olarak tanımlanabilir. Genellikle güneş gören alanlarda saç foliküllerinden köken aldığı varsayılmaktadır. Keratoakantom hakkındaki en yaygın tartışma ise malign ve benign arasındaki durumu ile ilgili olup, bu durum bir klinisyen için zorlayıcı, araştırmacı için de ilginç olabilmektedir. Çünkü bu tümör kanser regresyonunun anlaşılmasında anahtar rol oynayabilir. Keratoakantom, hem klinik hem de histolopatolojik bulgularda skuamöz hücreli karsinom benzerlik göstermekte ve tanı konulurken karıştırılabilmektedir 4,5. Bu karışıklıktan dolayı keratoakantomlar kurt görünümlü koyun olarak tanımlanabilirken, son zamanlarda skuamöz hücreli karsinom öncüsü görüşü artması nedeniyle koyun görünümlü kurt olarak da düşünülebilir. Biopsi materyalinin, subkütanöz yağ dokusununu içeren, total ya da kısmi eksizyonunu ya da merkezi ve her iki tarafı da dahil olmak üzere Keratoakantom 'un tamamı boyunca tüm lezyonu temsil edecek şekilde fusiform kısmi eksizyon yapılmasını önermişlerdir. Buna ilave olarak da her iki yanda sağlam deriden en az 2 mm biyopsi materyalinde kalacak şekilde eksizyon uygulanmalıdır.

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