Cutaneous horns:
· Cutaneous horns are unusual keratinous skin
tumors with the appearance of horns, or sometimes of wood or coral.
Formally, this is a clinical diagnosis for a "conical projection above the
surface of the skin.
· "They are usually small and localized but can, in very
rare cases, be much larger.
· Although
often benign, they can also be malignant or premalignant.
· The lesion at the base of the keratin mound is benign in the
majority of cases. Malignancy is present in up to 20% of cases,
with squamous-cell carcinoma being the most common type.
· The incidence of squamous-cell carcinoma increases to 37%
when the cutaneous horn is present on the penis. Tenderness at the base of
the lesion oftewn suggests the presence of a possible underlying squamous-cell
carcinoma.
· A cutaneous horn is more common in older patients, with the peak incidence in
those between 60 and 70.They are equally common in males and females, although
there is a higher risk of the lesion being malignant in men. They are
more common in people with fairer skins (skin phototype I and 2).
· Around half of horns have a benign base, and half are
premalignant or malignant. The most common underlying lesions are seborrhoeic keratosis, viral
warts (due to human papillomavirus), actinic keratosis, and well
differentiated squamous cell carcinoma (associated with
exposure to the sun and other sources of UV radiation).
Appearance:
· A cutaneous horn generally presents as a straight or
curved, hard, yellow-brown projection from the skin.
It can be surrounded by normal skin or have a border of thickened skin.The side of the horn may be terrace-like or oyster shell-like with horizontal ridges.
It can be surrounded by normal skin or have a border of thickened skin.The side of the horn may be terrace-like or oyster shell-like with horizontal ridges.
· The base of the horn may be flat, protruding, or like a
crater.
Inflammation may be present, due to recurrent injury.
Typically, the horn is taller than twice the width at the base.
It may vary from a few millimetres to several centimetres in size.
Inflammation may be present, due to recurrent injury.
Typically, the horn is taller than twice the width at the base.
It may vary from a few millimetres to several centimetres in size.
· Giant horns exist — the largest described is a 76-year-old
Parisian woman named Madame Dimanche (Widow Sunday) in the 19th century, who
grew a horn from her forehead that was 25-cm long.
Cutaneous horns are usually singular, but can be multiple.
They can occur anywhere on the body, but are more common on sun-exposed areas especially the head and ears, back of hands and forearms. They may also occur on the chest, neck, shoulder and penis.
Cutaneous horns are usually singular, but can be multiple.
They can occur anywhere on the body, but are more common on sun-exposed areas especially the head and ears, back of hands and forearms. They may also occur on the chest, neck, shoulder and penis.
Symptoms:
· Cutaneous horns are usually asymptomatic. They can be
injured causing pain and inflammation.
Associated conditions and problems:
· There are many other conditions that doctors
associate with cutaneous horns. The conditions and complications range from
benign to cancerous.
· Benign
conditions associated with cutaneous horns include:
- pigmented growths on the skin called nevuses
- harmless, warty growths on the skin known as
seborrhoeic keratosis
- viral warts not
related to HPV
- viral skin infections, such as molluscum contagiosum
- psoriasis
·
While these conditions are not cancerous,
some of them may require medical treatment. These conditions include the viral
skin infections and psoriasis.
More
serious conditions associated with cutaneous warts include:
- squamous cell carcinoma or
Bowen’s disease
- basal cell carcinoma
- melanoma (very rarely)
- intraepidermal
carcinoma
- arsenical
keratosis
Keratoacanthoma:
Another growth,
keratoacanthoma, is a lesion that resembles a
small volcano. It can grow up to 2 centimeters (cm) in diameter in sun-damaged
skin. It may start as a small pimple,
then develop over a few months, before shrinking.
A doctor may recommend
surgery to reduce the risk of
it becoming malignant, as it can resemble squamous cell carcinoma (SCC).
·
Diagnosis and investigation of cutaneous horn:
A cutaneous horn is diagnosed by its clinical appearance.
Histological examination of the horn base is crucial to rule out malignancy, as there are no certain clinical features that can definitively distinguish benign lesions from skin cancer.
The lesion is usually completely excised. In some cases, a deep partial biopsy is taken to establish the diagnosis.
On histology, there is thickening of the stratum corneum or hyperkeratosis. Orderly horizontal parallel layers of keratin are associated more with benign lesions. Rapidly growing malignant lesions exhibit a more erratic growth. Acanthosis is often noted. The base of the lesion shows features of the underlying lesion.
A cutaneous horn is diagnosed by its clinical appearance.
Histological examination of the horn base is crucial to rule out malignancy, as there are no certain clinical features that can definitively distinguish benign lesions from skin cancer.
The lesion is usually completely excised. In some cases, a deep partial biopsy is taken to establish the diagnosis.
On histology, there is thickening of the stratum corneum or hyperkeratosis. Orderly horizontal parallel layers of keratin are associated more with benign lesions. Rapidly growing malignant lesions exhibit a more erratic growth. Acanthosis is often noted. The base of the lesion shows features of the underlying lesion.
Cutaneous horn: A mask to
underlying malignancy in mouth
A59-year-old
male reported with a chief complaint of a growth on the left side of upper lip.
The lesion had been present for the last 6 months with gradual increase in
size. Previously, the patient had undergone surgical excision of the lesion
twice in the same area from an outside clinic only to notice it regrow again.
He had the habit of smoking cigarettes for the past 25 years, around 20
cigarettes per day. The patient also gave a history of anemia for the past 1
month and was taking folic acid medication regularly. No other signs and
symptoms were present.
On close clinical examination, an exophytic growth was seen on the left corner of upper lip. The growth was about 1.5 cm in length and was brown. On palpation, the growth was firm to hard in consistency and was slightly tender. Intraoral examination revealed a grayish-white patch on the left commissural mucosa and the dorsum of tongue measuring about 3 cm × 1 cm in dimension. Both the white patches were nontender and nonscrapable in nature. Hard tissue examination revealed several missing teeth
On close clinical examination, an exophytic growth was seen on the left corner of upper lip. The growth was about 1.5 cm in length and was brown. On palpation, the growth was firm to hard in consistency and was slightly tender. Intraoral examination revealed a grayish-white patch on the left commissural mucosa and the dorsum of tongue measuring about 3 cm × 1 cm in dimension. Both the white patches were nontender and nonscrapable in nature. Hard tissue examination revealed several missing teeth
Cutaneous Horn of
the Eyelid
A 19-year-old male patient, resident in a the rural area, was
admitted to the Ophthalmology Clinic for a solitary firm horn on the lower
eyelid, which had gradually progressed over the course of two months. One year
before, the patient noticed a focal swelling of the inferior eyelid treated
empirically, on which the cone shape growth developed progressively. The
patient’s medical and ocular history was not significant.
The clinical examination revealed a solitary cone shape
hyperkeratotic growth mesuring 1.0/0.6 cm in size, with an inflamed nodular
base, located in the middle 1/3rd of the inferior right eyelid. There was no regional lymphadenopathy. The clinical diagnosis was that of
solitary inferior right eyelid cutaneous horn. The lesion was excised
completely with local anesthesia, and the defect was closed by sliding the skin
of the inferior eyelid and sutured with Vicryl .
References:
Mantese SA, Diogo PM, Rocha A, Berbert AL, Ferreira AK, Ferreira TC. Cutaneous horn: a retrospective histopathological study of 222 cases. An Bras Dermatol. 2010 Mar-Apr 2010;85(2):157-163.
Yu RC, Pryce DW, Macfarlane AW, Stewart TW. A histopathological study of 643 cutaneous horns. Br J Dermatol. May 1991;124(5):449-452.
Pyne J, Sapkota D, Wong JC. Cutaneous horns: clues to invasive squamous cell carcinoma being present in the horn base. Dermatol Pract Concept 2013;3(2):2
Copcu E, Sivrioglu N, Culhaci N. Cutaneous horns: are these le¬sions as innocent as they seem to be? World J Surg Oncol. 2004:3(2):18.
Cutaneous Horn – Medscape Reference
Mantese SA, Diogo PM, Rocha A, Berbert AL, Ferreira AK, Ferreira TC. Cutaneous horn: a retrospective histopathological study of 222 cases. An Bras Dermatol. 2010 Mar-Apr 2010;85(2):157-163.
Yu RC, Pryce DW, Macfarlane AW, Stewart TW. A histopathological study of 643 cutaneous horns. Br J Dermatol. May 1991;124(5):449-452.
Pyne J, Sapkota D, Wong JC. Cutaneous horns: clues to invasive squamous cell carcinoma being present in the horn base. Dermatol Pract Concept 2013;3(2):2
Copcu E, Sivrioglu N, Culhaci N. Cutaneous horns: are these le¬sions as innocent as they seem to be? World J Surg Oncol. 2004:3(2):18.
Cutaneous Horn – Medscape Reference
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