CASE REPORT |
https://doi.org/10.5005/jp-journals-10003-1414 |
Cutaneous Horn: A “Seemingly” Innocuous Marvel!!!
1Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College and Lok Nayak and Associated Hospitals, New Delhi, India
2Department of ENT and Head and Neck Surgery, Maulana Azad Medical College, New Delhi, India
3Department of ENT and Head and Neck Surgery, Maulana Azad Medical College, Ghaziabad, Uttar Pradesh, India
4Department of Pathology, Maulana Azad Medical College, New Delhi, India
Corresponding Author: Divya Gupta, Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College and Lok Nayak and Associated Hospitals, New Delhi, India, e-mail: divyagupta.leo@gmail.com
How to cite this article: Gupta D, Singh I, Mittal P, et al. Cutaneous Horn: A “Seemingly” Innocuous Marvel!!! Int J Otorhinolaryngol Clin 2022;14(1):31–32.
Source of support: Nil
Conflict of interest: None
ABSTRACT
Cutaneous horns are uncommon keratotic lesions. We report a cutaneous horn in conchal portion of the ear which turned out to be carcinomatous on histology. This case report highlights the malignant potential of such lesions and hence, the necessity to assess them histologically for complete treatment.
Keywords: Cutaneous horn, Ear horn, Skin lesions, Squamous cell carcinoma.
BACKGROUND
Cutaneous horns have been a matter of great public bewilderment throughout ages because of their striking similarity to animal horns. In ancient times, they were viewed as medical marvels and used by some opportunists for profit by showcasing them in public.
The term “cutaneous horn” is used for distinctive exophytic keratotic eruptions arising from the superficial layers of skin, associated with a wide spectrum of underlying pathology.1 The lesion needs active management for it may hide an ominous lesion underneath. We present a case report of a middle-aged male with a cutaneous horn in unusual location in cartilaginous portion of the ear in concha, which was later found to be malignant.
CASE DESCRIPTION
A 42-year-old man presented to the outpatient clinic with a 4-cm-hard conical excrescence in his left ear, which had been present for 2 years and was gradually increasing in size. There was no history of trauma, spontaneous bleeding, or ulceration. On examination, a horn measuring 4 × 1.5 cm was present in the conchal portion of his left ear (Fig. 1). A tentative diagnosis of a cutaneous horn with undetermined cause was made. The horn was completely removed under local anesthesia with underlying conchal cartilage and the defect was primarily repaired. Histopathology revealed microinvasive squamous cell carcinoma (Fig. 2).
Fig. 1: Clinical photograph showing cutaneous horn over conchal part of left pinna
Figs 2A to D: Histopathological picture of the lesion showing (A) Papillomatous appearance with surface keratinization; (B) Marked hyperkeratosis and parakeratosis; (C) Downward elongation of the proliferating epithelium with loss of basement membrane; (D) Focus of microinvasion with lymphocytic and eosinophilic infiltrate (hematoxylin and eosin, 400×)
DISCUSSION
Cutaneous horn or cornua cutanea is morphologically a conical circumscribed projection formed mostly of densely packed keratinous material mounted on a base of hyperproliferative skin, varying from few millimeters to many centimeters, which may hide an underlying benign/malignant condition.
Mantese et al.2 in their retrospective study of 222 cases of cutaneous horns found 41.44% to have benign alterations in their bases, 51.35% premalignant, and 7.21% malignant. The largest study by Yu et al.3 of 643 patients also suggested a striking 39% to have been hiding a malignant/premalignant lesion. A wide variety of epidermal lesions include seborrheic keratosis, verruca vulgaris, cutinic keratosis, Bowen’s disease, and squamous cell carcinoma. Hence, it is quintessential to recognize this entity and take further action to determine the nature of the condition at the base of lesion.
Most of these have been found in sites exposed to the sun and hence, include upper portion of face, nose, pinnae, scalp, and back of hands. However, they may also arise in sun-protected region. Though there are case reports citing helix of pinna as one of the most common sites, we are yet to come across any reported picture/literature of a cutaneous horn in concha.
Specific anatomical features like giant horns, wide base or a low height-to-base ratio, history of trauma, male gender, increased age, facial lesions, and coexistence of other malignant/premalignant lesions are associated with higher incidence of premalignant and malignant histology.4
CONCLUSION
It is important to determine the histological nature of cutaneous horns since they can be caused by a variety of underlying lesions including malignancy. Since most of them have been found in association with sunlight, the use of photoprotectors may benefit by preventing the disease.
REFERENCES
1. Akram H, Jing SS, Murahari S, et al. Cutaneous horn: case report. Br J Oral Maxillofac Surg 2011;49(1):73–75. DOI: 10.1016/j.bjoms.2009.09.019.
2. Mantese SAO, Diogo PM, Rocha A, et al. Cutaneous horn: a retrospective histopathological study of 222 cases. Braz Ann Dermatol 2010;85(2):157–163. DOI: 10.1590/s0365-05962010000200005.
3. Yu RCH, Pryce DW, Macfarlane AW, et al. A histopathological study of 643 cutaneous horns. Br J Dermatol 1991;124(5):449–452. DOI: 10.1111/j.1365-2133.1991.tb00624.x.
4. Stavroulaki P, Mal RK. Squamous cell carcinoma presenting as a cutaneous horn. Auris Nasus Larynx 2000;27(3):277–279. DOI: 10.1016/s0385-8146(00)00060-2.
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