Cryosurgery, Intralesional Methotrexate and Imiquimod for Keratoacanthoma: Tuning the Combination

Figure 1

Patient 1 with a 24 mm in maximal diameter keratoacanthoma. The patient was treated with weekly sessions of cryosurgery (liquid N₂, open spray, 2 cycles of 15 sec each), intralesional methotrexate (7.5 mg/weekly sessions) (Panels a–d) and daily application of imiquimod. Panel a: The tumor at baseline. Panels b–d: The tumor at weekly intervals at the days of cryosurgery and intralesional methotrexate. Panel e: Gradual tumor involution is achieved and the patient is treated with daily imiquimod for another week (35 days imiquimod in total). Panel f: The tumor has cleared and a deep scar has remained, representing the “tumor ghost”, i.e., the area destroyed by the rapidly expanding keratoacanthoma. Photographs were acquired with modification of a previously used equipment [20] employing a Nikon D610 camera with a spatial resolution of 6016 × 4016 pixels. A 60 mm prime lens was adapted with a vertical polarized filter and a SIGMA EM-140 Macro ring flash with an additional vertical polarized filter. The photographs were taken with the axons of polarization of the two filters in vertical position to each other for cross-polarization to enhance the visualization of the vascular bed [21].

(a)

(b)

(c)

(d)

(e)

(f)