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We describe three cases of keratoacanthomas KAs following definitive volumetric modulated arc therapy VMAT for skin field cancerisation SFC One lesion arose on a back in an area that had received a total of Gy in fractions It first became apparent at days post RT and resolved without treatment by days The other arose on a nasal alar in the beam penumbra that received Gy in fractions appearing at days and resolving without treatment by days A third case occurred in an immunosuppressed patient developed KAs in one of two areas irradiated with lesions appearing at days post RT and finally resolving at days despite acitretin The area received a total dose of Gy in fractions Spontaneous resolution of index KA confirmed the diagnosis in all cases On average the patients were the area bearing the KA had received an average of Gy in fractions The average onset of the KAs was days or weeks or one month after RT and always soon after reepithelization was completed Resolution was at an average of days or weeks or months after the completion of RT In all three cases other lesions arose adjacent to them and in each case one of these other lesions was excised with histopathology confirming squamo proliferative lesions There has been no recurrence at least months after the last follow up To our knowledge these are the first three cases of KA described following definitive VMAT for SFC The possibility of KA arising after RT does need to be considered during the consent process

Keratoacanthomas following definitive volumetric modulated arc radiotherapy for skin field cancerization