Histopathology

Keratoacanthomas show a verrucous surface, and underneath keratinized clefts and penetrating squamous rete processes are found with deep keratin pearls. Atypia is minimal, and mitotic figures are rare or absent. Dense inflammatory infiltrates, including granulocytes typically are found in the adjacent stroma and within the deep parts of the tumour, so that the margins seem ill defined. The

Fig. 4.28 Keratoacanthoma of the mucosal aspect of the upper lip with the cup-shape margin on the right, and the keratin-filled crater that is in the centre of the lesion on the left.

Fig. 4.29 Keratoacanthoma. A Intraoral keratoacanthoma with a marginal lip and a cup-shaped lesion, in this case with parakeratotic keratin, and the typical dense inflammatory infiltrate at the epithelial-stromal interface. B The higher magnification reveals the inflammatory infiltrate in detail, and the absence of cellular atyp-ia in the lesional epithelium.

Fig. 4.29 Keratoacanthoma. A Intraoral keratoacanthoma with a marginal lip and a cup-shaped lesion, in this case with parakeratotic keratin, and the typical dense inflammatory infiltrate at the epithelial-stromal interface. B The higher magnification reveals the inflammatory infiltrate in detail, and the absence of cellular atyp-ia in the lesional epithelium.

hallmark of keratoacanthoma is the overall architecture, with a cup-shaped appearance and a collar-like circumference.

A major diagnostic problem arises when destructive infiltration takes place as has been reported, including some cases in young individuals. When this kind of tumour growth occurs in the elderly, it is of course extremely difficult or even impossible to distinguish the lesion from carcinoma, particularly from carcinoma cuniculatum, which also shows minimal atypia despite its destructive growth pattern {1929}.

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