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Short Communication Cutaneous horn of scalp.

Sir, cutaneous horn (cornu cutanneum) is a relatively rare protruded lesion from the skin resembling the horn of an animal. This lesion may be associated with a benign, premalignant,or malignant lesion at its base.

A 68-year-old male, farmer by profession, reported with a swelling of scalp over the left frontal area of more than 10 yearrs duration. The lesion had been growing gradually and the patient was prompted to consult aftter listening to a radio-talk regarding cancer. The patient did not have any other co morbidityy and in the past( about 40 years back) had sufffered from burns which had left hypopigmented scars over the scalp. On examination, there was a hard horn-like lesion over a hypopigmented left frontoparietal area, measuring 3 cms x 3.5 cms x 2.5 cms high (Figure 1). Thhe horn had shallow furrows running along whole of the length. The lesion was excised in toto and histopathological examination revealed a cutaneous horn with compact hypperkeratosis and tricholemmal keratinized debris. There was no evidence of any premaalignant or malignant changes in the base of the lesion. The patient did not develop any recurrence upto 15 months follow up.

Discussion

Cutaneous horn (cornu cutaneum) is a relatively rare nodular skin lesion and comprises of keratised material organised in the shape of an animal horn.1 Cutanneous horns usually arise on sun-exposed skiin but can occur even in sun-protected areas and in any part of the body. This term 'cutaneous horn' is applied to lesions in which the heeight of the keratotic mass amounts to at least half of its diameter.2

The cutaneous horns are only morphologically similar to animal horns but are histologically quite different from them. The animal horns are composed of superficial hyperkeratotic epidermis, dermis, and centrally positioned bone. No such axially positioneed well-formed bone has been observed in the human horns.3

Cutaneous horn is believed to result from unusual cohesiveness of keratinized material from the superficial layers of thhe skin(startum corneum) or implanted deeply in the cutis.4 The base of the horn may be fllat, nodular, or crateriform and number of skin lesions can be found at the base of the cutaneoous horn. Over 60% of the lesions are beniign,5 however, malignant or premalignant lesiions might be associated in upto 20-40% f case.6 The benign skin conditions asssociated with cutanous horns7,8 include soolar keratosis, angioma, angiokeratoma, cutaneous leishmaniasis, lichenoid keratosis, epidermal nevi, epidermal acanthomaa, seborrheic keratosis, sebaceous adenoma, trichilemmoma, sebaceous molluscum and verruca vulgaris. Similarly the premalignant and malignant conditions associated with the horns7,8 include adenoacanthoma, actinic keratosis, Bowen's disease, arsenical keratosis, Paget's disease, Kaposi sarcoma, malignant melanoma, sebaceous carcinoma9 and squamous cell carcinoma.

No clinical features reliably distinguish between benign and malignant lesions. However, tenderness at the base and lesions of larger size should raise suspicion of malignancy.8

Treatment is surgical and comprises of excision of the lesion and histopathological analysis of the base to rule out malignancy.6

References

1. Michal M, Bisceglia M, Di Mattia A et al. Gigantic cutaneous horns of the scalp lesions with a gross similarity to the horns of animals: a report of four cases. Am J Surg Pathol 2002; 26: 789-94.

2. Bart RS, Andrade R, Kopf AW. Cutaneous horn. Acta Derm Venereol 1968; 48: 507-15.

3. Saraf S. Sebaceous horn: An interesting case. Indian J Dermatol 2007; 52: 59-60.

4. Menci'a-Gutie'rrez E, Gutie'rrez-Di'az E, Redondo-Marcos I et.al. Cutaneous horns of the eyelid: a clinicopathological study of 48 cases. J Cutan Pathol 2004; 31: 539- 43.

5. Schosser RH, Hodge SJ, Gaba CR, Owen LG. Cutaneous horn: a histopathologic study. South Med J 1979; 72: 1129.

6. Yu RC, Pryce DW, Macfarlane AW, Stewart TW. A histopathological study of 643 cutaneous horns. Br J Dermatol 1991; 124: 449.

7. Copcu E, Sivrioglu N, Culhaci N. Cutaneous horns: are these lesions as innocent as they seem to be? World J Surg Oncol 2004; 2: 18.

8. Larsen F, Ricotti C Cockerell JC. Cutaneous horn. E-medicine (webmed) 2009. Available from: URL: http://emedicine.medscape.com/article/10 56568

9. Kitagawa H, Mizuno M, Nakamura Y et al. Cutaneous horn can be a clinical manifestation of underlying sebaceous carcinoma. Br J Dermatol 2007; 156: 180- 2.

Sajad Ahmad Salati, Ajaz Rather Department of Surgery, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir-India Address for correspondence

Address for correspondence Dr. Sajad Ahmad Salati Lane 2, Bulbul Bagh, Barzullah, Srinagar,Kashmir. Email: docsajad@yahoo.co.in
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Publication:Journal of Pakistan Association of Dermatologists
Article Type:Letter to the editor
Geographic Code:9INDI
Date:Dec 31, 2010
Words:747
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