Keratoacanthoma is a benign epithelial skin tumor that originates from the pilosebaceous unit. It classically presents as a 1–2 cm dome-shaped lesion and commonly affects older adults in sun-exposed areas, such as the face, neck, and dorsum of the extremities. Keratoacanthoma is often confused with squamous cell carcinoma, as the two share similar clinical and histological features, calling for efficient diagnosis. Cumulative UV exposure and immunosenescence render the aging population more susceptible to the entity. Definite treatment includes surgical excision with follow-up to ensure complete removal and rule out underlying malignancy. In some cases, alternative treatments such as intralesional therapies or cryotherapy may be performed. This chapter explores the pathogenesis, clinical presentation, diagnostic challenges, and management strategies for keratoacanthoma in older adults, emphasizing the importance of distinguishing the entity from other skin conditions to optimize outcome.