Introduction: Keratoacanthoma is a benign keratinizing skin tumor which often spontaneously resolves but is difficult to differentiate from squamous cell carcinoma.Although the primary treatment is surgical excision, several alternative treatments have been described. In this study 10 patients with keratoacanthomas were treated with intralesional methotrexate by the senior author. This treatment is well described in the dermatology but not in plastic surgery literature Purpose: To present the results efficacy and safety of intralesional methotrexate in selected patients with keratoacantoma. Methods:The 10 patients treated had lesions in critical anatomic areas were surgical excision would have been disfiguring and would require a complex reconstruction, or did not consent to operative intervention. Injections were given on a weekly basis until the tumor resolved. Results: In 8 patients the tumor resolved completely with no complications after up to 6 injections. Two ultimately required excision and reconstruction.Follow up ranged between 2 months and 6 years with no recurrence.

Conclusions: Intralesional methotrexate is an easy, safe and effective method of treatment of keratoacanthoma especially in cases where excision is avoided or requires a complex reconstruction. Close follow up and patient compliance are important. The advantages and limitations of the treatment are discussed.