Acquired Digital Fibrokeratoma.

Acquired digital fibrokeratoma is a rare, benign tumor that mostly occurs on the fingers and toes and may appear to be a supernumerary rudimentary digit. It generally affects adult men and appears as a dome-shaped papule although it can also be elongated or pedunculated. Trauma is believed to be a triggering factor in some cases. We report a male patient with an acquired digital fibrokeratoma on a finger, shaped like a cutaneous horn, and a history of minimal repeated trauma and spontaneous remissions not previously described in the literature.

Unraveling the Enigma: A Report on a Rare Case of Cutaneous Horn, an Extraordinary Dermatological Occurrence.

A cutaneous horn is a rare, hyperkeratotic, projecting lesion that can be mostly found in sun-exposed areas of the skin. The base of the lesions can reveal an underlying malignancy. They can also be associated with several benign or pre-malignant dermatologic conditions. A biopsy of the base of the lesion and histopathological analysis are needed to confirm the diagnosis. Management depends on the underlying disease; however, surgical excision is the preferred treatment method.

Verruca Vulgaris-Associated Cutaneous Horn: A Case Report.

A cutaneous horn is a yellow or white-colored conical projection made up of complex keratin that arises from the surface of the skin. It is usually diagnosed clinically but requires histologic examination to rule out malignancy or determine the underlying lesion. Verruca vulgaris, a human papillomavirus-associated lesion, is a very common benign underlying lesion. We present a case of an 80-year-old female who presented with a cutaneous horn on a unique location, the proximal interphalangeal joint (PIP) of her left fourth digit. Post-excision biopsy revealed a diagnosis of a verruca vulgaris-associated cutaneous horn.

Giant Cutaneous Horn: Is It a Tip of An Iceberg? Two Case Reports and a Review of Literature.

Cutaneous horns are uncommon lesions which consist of proliferation of keratotic material resembling that of an animal horn. This lesion most commonly occurs in sun-exposed areas, particularly the face, ear, nose, forearms and dorsum of hands. The purpose of the study was to highlight the atypical presentation of squamous cell carcinoma as a giant cutaneous horn along with the review of literature. Case details were obtained from hospital records and clinical and histopathological findings were noted. Herein we report two cases of giant cutaneous horn associated with an underlying carcinoma presenting at an uncommon site. Both the patients were adults and had a chronic history of a skin lesion over the affected sites. Wide local excision was performed in both cases and histopathological examination confirmed the diagnosis of a cutaneous horn with a well differentiated squamous cell carcinoma at the base of the horn. Cutaneous horns are commonly associated with benign lesions and rarely with malignant conditions. It is imperative to biopsy the base of the horn to rule out any underlying malignancy. Proper surgical excision with adequate margins is the preferred treatment in case of an underlying malignancy.

Cutaneous Horn: A Masquerade to Underlying Keratotic Basal Cell Carcinoma.

Cutaneous horns are uncommon skin tumors consisting of keratotic material infrequently found on eyelids. We report the case of a 65-year-old male with a two-month history of cutaneous horn arising from the right lower eyelid. Histopathological examination following the excision biopsy disclosed a keratotic basal cell carcinoma (BCC). Basal cell carcinomas are slow-growing lesions with a history ranging from months to years. The keratotic form of basal cell carcinoma is a less common presentation of a cutaneous horn. A cutaneous horn is usually derived from an underlying lesion that may be benign, premalignant, or malignant. The diagnostic dexterity of keratotic BCC emphasizes the importance of histopathological confirmation in establishing the diagnosis and modifying management. To the best of our knowledge, this is the first case report of a keratotic basal cell carcinoma masquerading as a small cutaneous horn with such a short duration.

Humans with inherited T cell CD28 deficiency are susceptible to skin papillomaviruses but are otherwise healthy.

We study a patient with the human papilloma virus (HPV)-2-driven "tree-man" phenotype and two relatives with unusually severe HPV4-driven warts. The giant horns form an HPV-2-driven multifocal benign epithelial tumor overexpressing viral oncogenes in the epidermis basal layer. The patients are unexpectedly homozygous for a private CD28 variant. They have no detectable CD28 on their T cells, with the exception of a small contingent of revertant memory CD4+ T cells. T cell development is barely affected, and T cells respond to CD3 and CD2, but not CD28, costimulation. Although the patients do not display HPV-2- and HPV-4-reactive CD4+ T cells in vitro, they make antibodies specific for both viruses in vivo. CD28-deficient mice are susceptible to cutaneous infections with the mouse papillomavirus MmuPV1. The control of HPV-2 and HPV-4 in keratinocytes is dependent on the T cell CD28 co-activation pathway. Surprisingly, human CD28-dependent T cell responses are largely redundant for protective immunity.

Cutaneous Horn of the Glans.

Cutaneous horn is a protuberance constituted by compact keratinous material, with a hard consistence similar to a horn, which occurs more frequently in photoexposed areas. The authors describe a case of cutaneous horn on the glans considered a rare location. Verrucous carcinoma was the histopathological diagnosis of the base of the horn and lichen sclerosis, the precursor lesion.

Facial cutaneous horn in three different conditions: A highlight of a malignancy risk.

INTRODUCTION: Cutaneous horns are nodules composed of compact keratin that project above the surface of the skin. The purpose of this work is to show the danger that can constitute the cutaneous horns. PRESENTATION OF CASES: In this paper, the authors report series of three cases of facial cutaneous horns, which were respectively diagnosed as trichilemmal horn in a 79-years old patient, a cutaneous horn underlying epidermoid carcinoma in a 59-years old patient, and a basal cell carcinoma in an 80-years old patient. All patients were treated by surgical excision. DISCUSSION: Cutaneous horns are generally asymptomatic and generate above all cosmetic disorders placing the patient in great social discomfort, thus prompting him to seek medical advice. CONCLUSION: They emphasize the need for careful management of these lesions because of the high incidence of malignant histology.

Histopathological and clinical analysis of 204 patients with cutaneous horns / 中华皮肤科杂志

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.

Factors related to delayed treatment: A case report of a huge cutaneous horn and review of the literature.

We present a case of a man with a giant cutaneous horn over his frontal region. This case has been presented for the size of the lesion, due to delayed treatment, and to illustrate the reasons why the growth of this lesion has been possible in a western country, in the 21st century. It was a solitary, not painful lesion which caused significant aesthetic problems. The diagnosis was based on an ultrasonographic study and the treatment of choice was a surgical excision. This case is an opportunity to review the literature about the cutaneous horns, to talk about the main causes of delayed diagnosis and treatment of cutaneous lesions and, to define the role of the specialist in the assessment of emotions and patient support.

A Curious Case of Cutaneous Horn.

Cutaneous horns are uncommon lesions that occur as conical projections in various sun-exposed parts of the body. They are made of hyperkeratotic material and look similar to animal horns. These lesions lack a central bony core that differentiates them from the animal horns. They are frequently associated with various benign, premalignant, and malignant lesions, and therefore carry a clinical significance. We present a case of a 58-year-old gentleman who presented with a conical projection over the center of the forehead, which was clinically diagnosed as a cutaneous horn. Excision of the horn along with the base was done, and the histopathology revealed benign seborrheic keratosis as the underlying lesion. The excision of small lesions along with their bases or biopsy of the base of large lesions is of paramount importance in the management of cutaneous horns.

Penile cutaneous horn.

Cutaneous horns are cornified hyperkeratotic lesions on the skin, usually present on photo-exposed areas such as the face and scalp. Its presence on the penis is very rare. Here, we report a 35-year-old male presenting with penile cutaneous horn with successful management with wide local excision along with a review of other modalities of treatment of this rare entity.

Cutaneous horn: A rare subtype of juvenile xanthogranuloma.

Because of variability in the JXG shape and the extensive range of a cutaneous horn differential diagnosis, dermatologists should keep this diagnosis in their mind in the time of encountering with infants or children cases of cutaneous horn.

Penile Cutaneous Horn in a 22-month-old Child: A Rare Case Report.

Cutaneous horn is a horn-like hyperkeratotic lesion. Its presence over penis is unusual and rare. Herein, we report a case of horn of penis in a 22-month-old child.

Squamous Cell Carcinoma Manifested as a Cutaneous Horn: A Key to Early Detection.

We report a case of squamous cell carcinoma manifested as a cutaneous horn. A 92-year-old man was referred to our department for evaluation of a 3-month history of a keratotic cutaneous horn on the left side of his neck. The height of the cutaneous horn was larger than the diameter of erythema at the base. Histopathological examination showed a hyperkeratotic horn developing over a mass of large atypical keratinocytes with large hyperchromatic and pleomorphic nuclei. Based on these findings, a diagnosis of squamous cell carcinoma was made. A recent study showed that cutaneous horns in association with invasive squamous cell carcinoma had a tendency to have less height than the diameter of the base. In our case, however, the height of the cutaneous horn was larger than the diameter of the base, indicating that invasive squamous cell carcinoma sometimes shows a cutaneous horn that is higher than the diameter of the base. Thus, clinical finding of erythema at the base of the cutaneous horn would be a reliable feature for early detection of squamous cell carcinoma.

Cutaneous horn: A mask to underlying malignancy.

Cutaneous horns (cornu cutaneum) are uncommon lesions consisting of keratotic material resembling that of an animal horn. It is a conical- or cylindrical-shaped excessive hyperkeratosis of variable size ranging from few millimeters to several centimeters with a variable in size and shape, such as cylindrical, conical, pointed, transversely or longitudinally corrugated, or curved like a ram's horn. The lesions typically occur in sun-exposed areas, particularly the face, ear, nose, forearms and dorsum of hands. Even though 60% of the cutaneous horns are benign in nature, the possibility of skin cancer should always be kept in mind. The clinical diagnosis includes various benign and malignant lesions at its base. Lesions associated with cutaneous horn are keratosis, sebaceous molluscum, verruca, trichilemmal, Bowen's disease, epidermoid carcinoma, malignant melanoma and basal cell carcinoma. Herewith, we report a case of cutaneous horn on the upper lip vermillion masking the underlying malignancy at its base.