# New Insights into Pathogenesis and Management of Keratoacanthoma: A Narrative Review

## TL;DR

This review explores the diagnosis and treatment of keratoacanthoma, emphasizing new imaging techniques and the role of HPV in its development.

## Contribution

The paper highlights advances in non-invasive diagnostics and the emerging role of HPV in keratoacanthoma pathogenesis.

## Key findings

- Non-invasive techniques like dermoscopy and confocal imaging improve KA diagnosis and differentiation from SCC.
- β-genus HPV types are suggested as cofactors in KA carcinogenesis, especially under UV exposure.
- Alternative therapies like radiotherapy and topical agents offer options when surgery is not feasible.

## Abstract

Keratoacanthoma (KA) is a rapidly growing epithelial neoplasm characterized by clinical and histopathological features that often overlap with well-differentiated squamous cell carcinoma (SCC), posing diagnostic challenges. This review provides a comprehensive overview of KA, emphasizing advances in non-invasive diagnostic techniques such as dermoscopy, reflectance confocal microscopy (RCM), and line-field confocal optical coherence tomography (LC-OCT), which improve lesion characterization and differentiation from SCC. We discuss the histopathological phases of KA and highlight key features aiding in diagnosis. Furthermore, we explore the emerging role of human papillomavirus (HPV), particularly β-genus types, as a cofactor in KA carcinogenesis through modulation of apoptosis and DNA damage response pathways, especially under ultraviolet (UV) radiation exposure. Therapeutic strategies remain centered on complete surgical excision; however, alternative treatments, including radiotherapy, cryotherapy, topical agents, and systemic retinoids, are discussed with their respective benefits and limitations. Finally, we review current HPV vaccines and novel vaccine candidates targeting a broad spectrum of mucosal and cutaneous HPV types. This review underscores the importance of integrated diagnostic and therapeutic approaches to optimize KA management and highlights future directions in understanding its pathogenesis and treatment.