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Volume 2, Issue 3, Pages 206-208 (May 2016) Keratoacanthoma centrifugum marginatum: A diagnostic and therapeutic challenge Nicole Dominiak, MD, Ben Hayes, MD, PhD, Julie Swick, MD, Brian Leach, MD, John Maize, MD, Jonathan Ralston, MD JAAD Case Reports Volume 2, Issue 3, Pages 206-208 (May 2016) DOI: 10.1016/j.jdcr.2016.03.010 Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Keratoacanthoma centrifugum marginatum. The lesion began as a single erythematous papule that progressed to an irregular 7.5- × 3.5-cm boggy tumor on the left anterior knee approximately 1 year after localized trauma. JAAD Case Reports 2016 2, 206-208DOI: (10.1016/j.jdcr.2016.03.010) Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 A low-power view of the incisional biopsy with zonal changes from the periphery to the center of the lesion. The outer edge is characterized by pseudoepitheliomatous hyperplasia and a dense mixed inflammatory infiltrate both superficially as well as deep. Centrally, the lesion shows fibrosis and a lack of epidermal hyperplasia. (Hematoxylin-eosin stain; original magnification: ×2.) JAAD Case Reports 2016 2, 206-208DOI: (10.1016/j.jdcr.2016.03.010) Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 A high-power view shows islands of keratinocytes with squamous pearls and minimal atypia underlying pseudoepitheliomatous hyperplasia. (Hematoxylin-eosin stain; original magnification: ×20.) JAAD Case Reports 2016 2, 206-208DOI: (10.1016/j.jdcr.2016.03.010) Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 A high-power view shows the eosinophilic, glassy cytoplasm of the keratinocytes, minimal atypia, and a single mitotic figure near the basal layer. The dermal inflammatory infiltrate is a mixture of lymphocytes, histiocytes, eosinophils, and a few plasma cells. (Hematoxylin-eosin stain; original magnification: ×40.) JAAD Case Reports 2016 2, 206-208DOI: (10.1016/j.jdcr.2016.03.010) Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Clinical photo shows complete response within weeks of receiving 2 courses of intralesional 5-fluorouracil injections. JAAD Case Reports 2016 2, 206-208DOI: (10.1016/j.jdcr.2016.03.010) Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions