Cutaneous horn of the nasal vestibule. (Rhinoscopic Clinic).

A 53-year-old man complained of a right nasal obstruction of 3 months' duration that was progressively worsening. Telescopic examination of the nose revealed that a long brown exophytic lesion had arisen from the floor of the right nasal vestibule (figure, A) and had occluded the right nostril. No similar lesion was found on the left side. The patient also had a septal deviation to the right. No nasal polyps were noted, and no cervical adenopathy was present. The patient underwent excision of the lesion with primary closure. The lesion measured 2 X 0.3 X 0.3 cm (figure B). Pathology identified it as a cutaneous horn.

The nasal vestibule contains an epidermal layer of keratinizing squamous cells in addition to a dermal layer and a subcutaneous layer. Lesions in this area can be benign or malignant. Benign lesions include papillomas and cutaneous horns, which are not likely to recur after excision. Moreover, children sometimes manifest overlying crusting or inflammatory changes as a consequence of foreign-body insertion. The most common malignant lesion of the nasal vestibule is squamous cell carcinoma, which occurs four times as often in males as in females.(1) Squamous cell carcinomas undergo submental or preauricular lymph node metastasis in one-third of patients.(1)

Early excision is preferred for most lesions of the vestibule. With benign lesions, primary closure can be accomplished if the base of the attachment is narrow. With broader-based lesions, postoperative vestibular stenosis is a concern, and alternate methods of closure (e.g., healing by secondary intention or skin grafting) might be necessary.

Reference

(1.) Hyams VJ, Batsakis JG, Michaels L. Tumors of the Upper Respiratory Tract and Ear. Washington, D.C.: Armed Forces Institute of Pathology, 1998.