Multiple keratoacanthomas in a patient with myelodysplastic
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A 47-year-old woman presented at the dermatology clinic with multiple rapidly growing nodules on her right eyebrow and the right auricula that had been growing for 2 months. She also complained of unexplained fatigue during the past 2 months. She had been diagnosed with myelodysplastic syndrome 15 months previously, and had finished 7 cycles of treatment with decitabine (10 mg per day for 5–10 days each month) 3 months previously; aclarubicin at 10 mg per day for 4 days had been added during the fifth cycle, and azacytidine at 100 mg per day for 5 days had been added in the last two cycles.

Patient noticed two similar nodules on her eyebrows during the seventh cycle of chemotherapy, when she had grade 4 myelosuppression. The nodules regressed spontaneously within 8 weeks. Physical examination showed three flesh-pink, crateriform, keratotic nodules on her right eyebrow and the right auricula. The surrounding skin appeared normal and not sun damaged.

An incisional biopsy on the nodule on the right eyebrow showed an invaginating mass of keratinising, well differentiated squamous epithelium with a central keratin-filled crater and the lipping of the edges of the lesion overlapping the crater, leading to a diagnosis of keratoacanthoma.

A blood differential test showed severe pancytopenia with decreased leucocyte count (1·0 × 10 9 cells per L), haemoglobin concentration (42 g/L), and platelet count (10 × 10 9 cells per L), consistent with progression of myelodysplastic syndrome and associated dyshaematopoiesis. 5% imiquimod cream was applied on alternate days for the keratoacanthoma, and supportive treatments, including red blood cell and platelet transfusions, were initiated. A well tolerated skin inflammation was noted in the area of imiquimod application. The skin nodules gradually regressed within 8 weeks without relapse after 1 year of follow-up.

Source: https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(20)30363-X/fulltext?rss=yes
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