ABSTRACT
Objective:To analyze clinical and histopathological features of cutaneous horns, and to explore their relationship.Methods:A total of 204 patients with cutaneous horns confirmed by clinical and histopathological examinations were collected from Department of Pathology, Shanghai Skin Disease Hospital between January 2014 and May 2020, and their clinical and histopathological data were retrospectively analyzed.Results:Among 204 patients, there were 88 males and 116 females with the age being 70.47±14.76 years and median ( P25, P75) course being 6 (6, 24) months. Cutaneous horns were solitary in 201 cases, and multiple in 3. There were a total of 207 cutaneous horns, including 163 (78.74%) located on the head, face and neck, 18 (8.70%) on the trunk and 26 (12.56%) on the extremities. According to histopathological conditions at the base of the cutaneous horns, 154 (74.40%) cutaneous horns were considered to arise from benign lesions (named as benign horns) , including viral warts ( n=129) , seborrheic keratosis ( n=15) , inverted follicular keratosis ( n=3) , trichilemmomas ( n=5) , pyogenic granuloma ( n=1) and calcifying epithelioma ( n=1) ; 40 (19.32%) were considered to arise from premalignant lesions (actinic keratosis) and named as premalignant horns; 13 (6.28%) were considered to arise from malignant lesions (named as malignant horns) , including Bowen′s disease ( n=5) and squamous cell carcinoma ( n=8) . The average ages of patients with premalignant and malignant horns were significantly higher than those of patients with benign horns ( H=4.05, 3.16, respectively, both P < 0.01) . The base width of the malignant horns was significantly higher than that of the premalignant and benign horns ( H=2.74, 3.49, P < 0.05, 0.01, respectively) , and there was no significant difference between the premalignant and benign horns ( H=0.73, P > 0.05) . The height to base width ratio was significantly lower in the premalignant and malignant horns than in the benign horns ( H=4.06, 3.72, respectively, both P < 0.01) . The incidence rate of basal erythema was significantly higher in the premalignant and malignant horns than that in the benign horns ( χ2=29.57, 6.23, P < 0.01, 0.05, respectively) , and bleeding and crusting occurred more frequently in the malignant horns compared with the benign horns ( χ2=4.89, P < 0.05) . Conclusions:The base of most cutaneous horns is benign, which mainly includes viral warts, and premalignant and malignant horns account for about a quarter. Male, older age, wide base, low ratio of the height to base width, basal erythema, history of bleeding and crusting can serve as clues to early recognition of malignant lesions at the base of cutaneous horns.
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.
Subject(s)
Aged , Animals , Female , Humans , Carcinoma, Squamous Cell , Horns , Keratinocytes , Keratosis, Actinic , PathologyABSTRACT
A 81-year-old female presented with a giant cutaneous horn (1.5×2×4 cm sized) over the right hand, rapid growth recent 6 months. Cutaneous horn was excised and split thickness skin graft of the defect was done under regional anesthesia. Histopathology showed overlying a wart. In the current study, we report the case of a patient with giant wart as a giant cutaneous horn in a dorsal side of hand.
Subject(s)
Aged, 80 and over , Animals , Female , Humans , Anesthesia, Conduction , Hand , Horns , Skin , Transplants , WartsABSTRACT
El cuerno cutáneo es un concepto semiológico. Se define como una lesión tumoral hiperqueratósica de aspecto cónico y tamaño variable, que puede tener como base una lesión de origen benigno, premaligno o maligno. El tratamiento consiste en la resección completa de la lesión, seguido de un estudio histopatológico para precisar el diagnóstico. El carcinoma sebáceo, neoplasia maligna derivada del epitelioanexial de las glándulas sebáceas, se ha descrito como una etiología poco frecuente de cuerno cutáneo. Su diagnóstico es difícil, ya que carece de elementos clínicos característicos y su histología puede ser similar al carcinoma espinocelular o basocelular, pero importante ya que constituye una neoplasia agresiva, con riesgo de recurrencia local y metástasis. A continuación, presentamos el caso de un hombre de 68 años con diagnóstico clínico de cuerno cutáneo palpebral y diagnóstico histopatológico de carcinoma sebáceo.
The cutaneous horn is a semiological concept. It is defined as an hyperkeratotic tumor of conical appearance and variable size, which may be based on benign, premalignant or malignant lesion. The treatment is the complete resection followed by an histopathology study to clarify the diagnosis. Sebaceous carcinoma, malignant neoplasm derived from adnexal epithelium of sebaceous glands, has been described as a rare etiology of cutaneous horn. Diagnosis is difficult because it doesnt have characteristic clinical features and histology may be similar to squamous or basal cell carcinoma, but it is important because is an aggressive neoplasm with risk of local recurrence and metastasis. We present a case of a 68-year-old man, with a clinical diagnosis of eyelid cutaneous horn and histopathological diagnosis of sebaceous carcinoma.
Subject(s)
Humans , Male , Aged , Adenocarcinoma, Sebaceous/pathology , Sebaceous Gland Neoplasms/pathology , Eyelid Neoplasms/pathology , Adenocarcinoma, Sebaceous/surgery , Adenocarcinoma, Sebaceous/diagnosis , Sebaceous Gland Neoplasms/surgery , Sebaceous Gland Neoplasms/diagnosis , Eyelid Neoplasms/surgery , Eyelid Neoplasms/diagnosis , PrognosisABSTRACT
Cutaneous horn is the clinical description of a hyperproliferation of compact keratin in response to a wide array of underlying benign and malignant pathologic changes. We report here on a case of cutaneous horn that originated from keratoacanthoma in a 76-year-old woman. Grossly, a 2.5x0.7 cm sized yellow-white colored scaly fungating mass from an erythematous nodule was observed on the right temporal area. Histopathologically, it was reported as keratoacanthoma with cutaneous horn. The lesion was totally excised after the diagnosis.
Subject(s)
Aged , Animals , Female , Humans , Horns , Keratins , KeratoacanthomaABSTRACT
Pseudoepitheliomatous, keratotic, and micaceous balanitis is an extremely rare condition occurring over the glans in elderly characterized by silvery white plaque with mica-like crust, which can undergo malignant transformation. Herein we present a case of pseudoepitheliomatous, keratotic, and micaceous balanitis occurring in an adult male presenting as a cutaneous horn.
ABSTRACT
El cuerno cutáneo es un diagnóstico clínico que describe una lesión hiperqueratósica con forma de cuerno.El presente estudio determina las características del cuerno cutáneo según sexo, rango de edad, localización anatómica, diagnóstico histológico y presencia de malignidad en una serie de 93 casos. El promedio de edad de la muestra fue de 67,9 años. El 59,1 por ciento de las lesiones se localizó en la cara, especialmente en las mejillas. El 61,3 por ciento de los cuernos cutáneos fue benigno y el 38,7 por ciento fue no-benigno, siendo el 25,8 por ciento lesiones malignas in situ y el 12,9 por ciento, malignas. No existió diferencia según sexo. El total de las lesiones malignas se presentó en la cabeza. El diagnóstico histológico más frecuente fue el de verruga vulgar (28,0 por ciento). La lesión maligna más frecuente fue el carcinoma espinocelular (10,8 por ciento), más común en mayores de 70 años. La prevalencia de lesiones malignas in situ o malignas fue de 66,7 por ciento en mayores de 70 años versus 15,7 por ciento en menores de 70 años (p < 0,001).La importancia del cuerno cutáneo radica en la patología que le subyace. En mayores de 70 años la probabilidad de tener una lesión no-benigna (maligna in situ o maligna) es mayor que en pacientes más jóvenes.
Cutaneous horn is a clinical diagnosis that describes an hyperkeratotic lesion with shape a horn.This study describes the characteristics of cutaneous horns according to sex, age, localization, histological diagnosis and the presence of malignancy in a series of 93 cases.The mean age of the sample was 67.9 years. 59.1 percent of the lesions were localized on the face, especially on the cheeks. 61.3 percent of cutaneous horns were benign and 38.7 percent were non-benign. 25.8 percent were malignant in situ and 12.9 percent malignant lesions. There was no difference among sexes. All malignant lesions were localized on the head. The most common histological diagnosis was warts (28.0 percent). The most common malignant lesion was squamous cell carcinoma (10.8 percent), which was more frequent in patients older than 70 years. In patients older than 70 years, the prevalence of malignant in situ or malignant lesions was 66.7 percent, versus 15.7 percent in younger patients (p < 0,001).The importance of cutaneous horns is the nature of its underlying disease. In patients older than 70 years, the probability of having a non-benign lesion (malignant in situ or malignant) is higher than in younger patients.Key words: Cutaneous horn, cutaneous biopsy, squamous cell carcinoma.
Subject(s)
Humans , Male , Female , Aged , Skin Diseases/epidemiology , Skin Diseases/pathology , Age Distribution , Biopsy , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/pathology , Chile/epidemiology , Skin Neoplasms/epidemiology , Skin Neoplasms/pathology , Precancerous Conditions , Keratosis/epidemiology , Keratosis/pathology , Retrospective Studies , Warts/epidemiology , Warts/pathologyABSTRACT
Cutaneous horn is a clinical description for a protruding mass of keratin, which may arise from benign and malignant lesions. There have been 21 cases of cutaneous horns reported in Korea: 19 cases in adults, 2 cases in children, and no case in infants. We report the case of an 8-month-old girl who presented with a pea-sized, hyperkeratotic nodule on the dorsum of the right foot. Histopathologic examination confirmed the nodule to be a cutaneous horn arising from an angiokeratoma.
Subject(s)
Adult , Animals , Child , Female , Humans , Infant , Angiokeratoma , Foot , Horns , KoreaABSTRACT
Cutaneous horn is a relatively rare tumor, and is characterised as a protrusion of keratinized material from the skin in the shape of a horn. The lesion can be derived from many primary underlying lesions which may be benign, premalignant or malignant, so it is important to determine an accurate condition at the base of the lesion. We report a case of cutaneous horn on the right middle finger of a 63 year old woman. A 0.8 X 0.5 X 0.4 sized, dark-brownish protruding papule was observed. Histopathologic findings showed prominent orthokeratotic hyperkeratosis and findings at the base of the lesion were consistent with acquired digital fibrokeratoma.
Subject(s)
Animals , Female , Humans , Middle Aged , Fingers , Horns , SkinABSTRACT
El cuerno cutáneo es una lesión tumoral de aspecto cónico cuya longitud prevalece sobre el diámetro, con gran hiperqueratosis en su extremo y variadas causas e histología pudiendo tener como base una lesión benigna, premaligna o maligna. Su diagnóstico inicial es clínico, sin embargo para descartar malignidad como patología de base siempre es necesario su exéresis quirúrgica y estudio histopatológico. Presentamos dos casos con localización en semimucosa de labio inferior, uno de ellos con aparición simultánea de dos lesiones, manifestación rara en este tipo de tumores, según la literatura. Destacamos la reparación quirúrgica de estas lesiones, efectuando una exéresis en cuña, conservando la forma y funcionalidad del labio.
The cutaneous horn is a conical tumoral lesion whose height is prevalent over the diameter of its base, characterized by hyperkeratotic appearance associated with multiple causes and histological development over benign, premalignant and malignant lesions. The primary diagnosis is mainly suggested by the appearance and course of these lesions, however to discard a malignant base pathology always is necessary the surgical excision and histopathological examination. We report two cases with clinical characteristics in mucosa of the lower lip and simultaneous growth of two lesions together, infrequent observations of this entity in literature reviews. We want to remark the surgical excision of these lesions preserving the shape and function of the lip.
Subject(s)
Humans , Male , Female , Aged , Lip Diseases/pathology , Lip Diseases/surgery , Lip Diseases/diagnosis , Lip Neoplasms/surgeryABSTRACT
Malignant eccrine poroma is a rare skin appendage tumor, originating from the intraepidermal eccrine duct. It develops either spontaneously or in an eccrine poroma of long-standing duration. It usually affects older people and is located most commonly on the lower extremities. We report a case of an 84 year old woman with a malignant eccrine poroma on the left upper eyelid, which resembled a cutaneous horn. She presented with a solitary, tender, firm, 0.4x0.4x0.9 cm-sized, silvery-white colored papule on the left upper eyelid. She was treated with surgical excision and to date shows no recurrence.
Subject(s)
Aged, 80 and over , Animals , Female , Humans , Eccrine Porocarcinoma , Eyelids , Horns , Lower Extremity , Poroma , Recurrence , SkinABSTRACT
Cutaneous horn is a nonspecific clinical description and may arise from a variety of benign and malignant lesions. A 46-year-old Korean man presented with a 1-year history of an extensively hyperkeratotic nodule on his left foot. Following an initial diagnosis of dermatofibroma with underlying cutaneous horn by wedge biopsy, the tumor was completely removed by excision with 5 mm margin. When excisional surgery was performed, the size of the dermal tumor mass was found to be 1.3 cm in length on the axis and 0.6 cm in depth on section. On histopathologic examination, the tumor was characterized by spindle-shaped cells arranged in storiform pattern, epidermal hyperplasia, and an overlying compact hyperkeratotic mass. The tumor cells did not express CD34. Cutaneous horn of dermatofibroma may be the product of epidermis-dermal tumor interaction. Although we performed a wide excision for complete removal of the tumor, Mohs micrographic surgery could have been another option.
Subject(s)
Animals , Humans , Middle Aged , Axis, Cervical Vertebra , Biopsy , Diagnosis , Foot , Histiocytoma, Benign Fibrous , Horns , Hyperplasia , Mohs SurgeryABSTRACT
Cutaneous horn is a clinical description for a cohesive mass of cornified material protruding from the surface of the skin. These lesions may arise from a bulging erythematous base, and their shape is usually described as conical. Such lesions generally occur on sun exposed areas such as the face, ear or the dorsum of the hand. Cutaneous horn is not a pathological diagnosis and a variety of primary underlying processes can cause this lesion. We report an 85-year-old female who presented with a bean-sized, hyperkeratotic nodule on the right lower leg. Clinical and histopathologic examination confirmed the nodule to be squamous cell carcinoma presenting as cutaneous horn.
Subject(s)
Aged, 80 and over , Animals , Female , Humans , Carcinoma, Squamous Cell , Diagnosis , Ear , Hand , Horns , Leg , Skin , Solar SystemABSTRACT
Cutaneous horn is a morphologic designation for a projectile, conical, dense hyperkeratotic nodule that resembles the horn of an animal. The lesion varies in size from only a few millimeters to several centimeters, in color(white or yellowish) and in form (straight, curved, or twisted). It arises from a wide range of epidermal lesions, which include benign lesions, premalignant lesions and malignant lesions. An 83-year-old women came to our clinic with a giant cutaneous horn on the right chin and a small horn on the left upper eyelid. The patient had no palpable cervical lymph node. A wide elliptical skin incision was made and the horn was totally excised. In pathology, the giant cutaneous horn on the right chin revealed a moderately differentiated squamous cell carcinoma with subcutis invasion at its base. "Giant cutaneous horns" have often been associated with invasive squamous cell carcinoma. Cutaneous horns are common lesions usually found on the face, rarely larger than 2cm. As large cutaneous horns are often associated with underlying malignancy, histopathologic examination of the base of the lesion is necessary to rule out carcinoma and full excision is recommended.
Subject(s)
Aged, 80 and over , Animals , Female , Humans , Carcinoma, Squamous Cell , Chin , Eyelids , Horns , Lymph Nodes , Pathology , SkinABSTRACT
BACKGROUND: Cutaneous horn is a morphological designation for a protuberant mass of keratin that resembles the horn of an animal. This reaction pattern is often seen in the background of a variety of primary diseases such as the benign, premalignant, or malignant tumors, and can mask numerous conditions. OBJECTIVE: The purpose of this study was to investigate clinical and histopathological features of cutaneous horns, especially focusing on the underlying diseases. METHOD: We reviewed the medical records and biopsy specimens of 72 cases of cutaneous horns which were diagnosed between January 1991 and July 2004 in 8 hospitals under the charge of Catholic Medical Centers. RESULTS: We compiled clinical data and histologic information on the 72 cases of cutaneous horns as follows: 1. The mean age at diagnosis was 54.3 years, and 69.7% of the patients were over 50 years old. Cutaneous horn developed predominantly in female, as the sex ratio of 1: 1.2. 2. The disease duration did not exceed 1 year in 55.5% of patients. Most patients were asymptomatic, but 11.6% and 15.9% of patients complained of pruritus and pain, respectively. The lesions were usually solitary. 3. Cutaneous horns occurred on the face and neck, trunk, and extremities in 73.6%, 12.5%, and 13.9% of cases respectively, and cheeks, neck, scalp and hands were found to be commonly involved. 4. Histopathologically, 79.2% of cutaneous horns were associated with benign specimens at the base pathology, 15.3% were premalignant, and 5.6% were caused by malignant skin disease. With the benign pathological cases, common lesion were viral warts, and in premalignant cases, actinic keratosis. The malignant lesions were found to consist of squamous cell carcinoma and basal cell carcinoma. 5. Four main features were associated with premalignant or malignant histopathological changes at the base of the cutaneous horns. These were older age, female sex, shorter duration of illness, accompanied pain. CONCLUSION: Cutaneous horn is the term given to a protrusion of keratinized material on the skin, and is often found to arise on sun-exposed skin in elderly men. It may be derived from a benign, premalignant, or malignant lesion. Benign lesions were found to occupy most of the base pathology in Korea. However, because of the possibility of masking malignant lesions, sufficient specimens from the base of lesions should be carefully obtained.
Subject(s)
Aged , Animals , Female , Humans , Male , Middle Aged , Biopsy , Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Cheek , Diagnosis , Extremities , Hand , Horns , Keratosis, Actinic , Korea , Masks , Medical Records , Neck , Pathology , Pruritus , Scalp , Sex Ratio , Skin , Skin Diseases , WartsABSTRACT
Cutaneous horn is a clinical diagnosis based upon the presence of a large protuberant mass of keratin. We report a case of cutaneous horn arising from dermatofibroma in a 31-year old woman. A silver whitish colored comical hyperkeratotic protruding lesion (1.0 0.7 cm size) from the red brown colored nodule was observed. Histopathologic findings showed characteristic findings of dermatofibroma and cutaneous horn. The lesion was removed by surgical excision.