Case 30: Does this need draining?
Wednesday, September 28th, 2011Author: Dr Ian Stell
This is the back of the right hand of a 71 year-old female who was referred by her GP. She had suffered a minor injury to the back of her hand when a blind fell heavily on it a week earlier. She noticed a lump, her doctor thought this was infected and gave her antibiotics. It is no better and the GP has requested incision and drainage.
1. What is this?
Click to see the answerThis is a keratoacanthoma. This is a low grade malignancy related to squamous cell carcinoma. It grows rapidly, reaching 1-2cms in days or weeks, usually in sun-exposed areas. There is often a history of minor trauma. Left alone they grow so rapidly that they exceed their blood supply, become necrotic and slough off. They are normally excised, as a small percentage will eventually spread and metastasise.
2. How is this recognised?
Click to see the answerThe classical history is of rapid growth, usually on the backs of the hands, face or legs. They are normal painless. The lesions are dome-shaped with a central plug of keratin.