Interestingly, the uptake of carcinogens (e.g. via particular smoking habits) may be relevant in human tumours {641}. No other risk factors are known. The concept of a common viral origin (papillomavirus-es), popular for some years, has been abandoned.

In addition to the solitary type, clinical variants with multiple keratoacanthomas have been described, sometimes with a unilateral distribution {881}. Genetic factors may be involved in these cases, for familial clustering occurs, with multiple keratoacanthomas in affected individuals.

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