Cutaneous Horn in Premalignant and Malignant Conditions

Abstract

Cutaneous horns are conical, circumscribed protuberances formed by densely layered keratin. These lesions originate from basal keratinocytes and may manifest as benign, premalignant, or malignant cutaneous pathology in chronically sun-damaged areas. Complete surgical excision with histologic examination is needed for potential malignancy. In this report, we describe two elderly women presenting with solitary facial cutaneous horns, which were respectively diagnosed as actinic keratosis and squamous cell carcinoma.

Cutaneous horn in a sun-protected site harbouring unusual malignancy

“…Cutaneous horns are conical, circumscribed protuberances, which are formed by the laying down of densely adherent keratin. 1 Owing to their nature, they originate from basal keratinocytes. 1 They are an uncommon occurrence, with a frequency of 0.3-1.3% noted in the largest published study of cutaneous horns.…”

“…1 Owing to their nature, they originate from basal keratinocytes. 1 They are an uncommon occurrence, with a frequency of 0.3-1.3% noted in the largest published study of cutaneous horns. 2 Cutaneous horn was defined by Bart et al as a hyperkeratotic lesion in which height corresponds to at least half of the diameter of its base.…”

“…These lesions can occur all over the body, with a preponderance for sun-exposed surfaces, most commonly the face and scalp. 1 They are uncommon, having a frequency of around 1% and are structurally hyperkeratotic lesions. 2,3 They mostly attributed to benign lesions, however up to 15% of cutaneous horns are thought to harbor hidden malignancies.…”

“…2,3 They mostly attributed to benign lesions, however up to 15% of cutaneous horns are thought to harbor hidden malignancies. 1 Squamous cell carcinoma is the most commonly encountered malignancy in conjuncture with cutaneous horns, and the direct relationship between two is most easily demonstrated by association of both conditions with keratin. 1 Usually asymptomatic and only a cosmetic defect, cutaneous horns are often ignored for long periods, allowing malignant transformation to occur unhindered.…”

“…1 Squamous cell carcinoma is the most commonly encountered malignancy in conjuncture with cutaneous horns, and the direct relationship between two is most easily demonstrated by association of both conditions with keratin. 1 Usually asymptomatic and only a cosmetic defect, cutaneous horns are often ignored for long periods, allowing malignant transformation to occur unhindered. It is thus imperative that these structures are investigated even when not symptomatic, so that early intervention can be undertaken when necessary.…”