Cutaneous Horn Clinical Presentation

  • Author: Fiona Larsen, MBChB, FRACP; Chief Editor: William D James, MD   more...
 
Updated: Jan 12, 2012
 

History

Cutaneous horns usually are asymptomatic. Because of their excessive height, they can be traumatized. This may result in inflammation at the base with resulting pain. Rapid growth may occur.

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Physical

The distribution of cutaneous horn usually is in sun-exposed areas, particularly the face, pinna, nose, forearms, and dorsal hands.[20, 21] It is a hyperkeratotic papule with the height greater than one-half the width of the base. Usually a cutaneous horn is several millimeters long.

A typical presentation of a cutaneous horn on the A typical presentation of a cutaneous horn on the ear. An unusually large cutaneous horn extending from tAn unusually large cutaneous horn extending from the ear.
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Causes

Malignant lesions at the base of the horn usually are squamous cell carcinoma, although basal cell carcinoma has been rarely reported. These are predominately precipitated by ultraviolet radiation. Rare tumors at the base include Paget disease of the breast, sebaceous adenoma, and granular cell tumor. The premalignant lesion, actinic keratosis, is a frequent finding at the base. The human papilloma virus most frequently causes infectious etiology resulting in a verruca vulgaris.[17] Molluscum contagiosum of the poxvirus group occasionally has formed a cutaneous horn. The only other infectious cause has been leishmaniasis.

Benign idiopathic causes are frequent and include seborrheic keratosis, epidermal nevus, trichilemmal cyst, trichilemmoma, prurigo nodule, and intradermal nevus.

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Contributor Information and Disclosures
Author

Fiona Larsen, MBChB, FRACP  Dermatologist/Dermatopathologist, Private Practice; Consultant Dermatologist, Waitemata District Healthboard

Disclosure: Nothing to disclose.

Coauthor(s)

Carlos Ricotti, MD  Fellow, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern School of Medicine

Carlos Ricotti, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, and International Society of Dermatopathology

Disclosure: Nothing to disclose.

Clay J Cockerell, MD  Director, Clinical Professor, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern Medical Center

Clay J Cockerell, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, International Academy of Pathology, International AIDS Society, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, Society for Investigative Dermatology, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

R Stan Taylor, MD  The JB Howell Professor in Melanoma Education and Detection, Departments of Dermatology and Plastic Surgery, Director, Skin Surgery and Oncology Clinic, University of Texas Southwestern Medical Center

R Stan Taylor, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, Christian Medical & Dental Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Nancy Silvis, MD, to the development and writing of this article.

References

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  2. Dabski K, Stoll HL. Cutaneous horn arising in chronic discoid lupus erythematosus. Arch Dermatol. Jul 1985;121(7):837-8. [Medline].

  3. Goette DK. Cutaneous horn overlying granular cell tumor. Int J Dermatol. Nov 1987;26(9):598-9. [Medline].

  4. Findlay RF, Lapins NA. Pyogenic granuloma simulating a cutaneous horn. Cutis. Jun 1983;31(6):610-2. [Medline].

  5. Brownstein MH, Shapiro EE. Trichilemmomal horn: cutaneous horn overlying trichilemmoma. Clin Exp Dermatol. Mar 1979;4(1):59-63. [Medline].

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  7. Sandbank M. Basal cell carcinoma at the base of cutaneous horn (cornu cutaneum). Arch Dermatol. Jul 1971;104(1):97-8. [Medline].

  8. Onak Kandemir N, Gun BD, Barut F, Solak Tekin N, Ozdamar SO. Cutaneous Horn-Related Kaposi's Sarcoma: A Case Report. Case Report Med. 2010;2010:[Medline]. [Full Text].

  9. Yang JH, Kim DH, Lee JS, Cho MK, Lee SH, Lee SY, et al. A case of cutaneous horn originating from keratoacanthoma. Ann Dermatol. Feb 2011;23(1):89-91. [Medline]. [Full Text].

  10. Wollina U, Schönlebe J. Giant keratoacanthoma-like cutaneous horn of the upper leg: A case report. Acta Dermatovenerol Alp Panonica Adriat. 2010;19(2):29-30. [Medline].

  11. Cristobal MC, Urbina F, Espinoza A. Cutaneous horn malignant melanoma. Dermatol Surg. Aug 2007;33(8):997-9. [Medline].

  12. Dabski K, Stoll HL Jr. Paget's disease of the breast presenting as a cutaneous horn. J Surg Oncol. Aug 1985;29(4):237-9. [Medline].

  13. Peterson JL, McMarlin SL. Metastatic renal-cell carcinoma presenting as a cutaneous horn. J Dermatol Surg Oncol. Oct 1983;9(10):815-8. [Medline].

  14. Brauninger GE, Hood CI, Worthen DM. Sebaceous carcinoma of lid margin masquerading as cutaneous horn. Arch Ophthalmol. Nov 1973;90(5):380-1. [Medline].

  15. Kitagawa H, Mizuno M, Nakamura Y, Kurokawa I, Mizutani H. Cutaneous horn can be a clinical manifestation of underlying sebaceous carcinoma. Br J Dermatol. January 2007;156(1):180-2. [Medline].

  16. Korkut T, Tan NB, Oztan Y. Giant cutaneous horn: a patient report. Ann Plast Surg. Dec 1997;39(6):654-5. [Medline].

  17. Solivan GA, Smith KJ, James WD. Cutaneous horn of the penis: its association with squamous cell carcinoma and HPV-16 infection. J Am Acad Dermatol. Nov 1990;23(5 Pt 2):969-72. [Medline].

  18. Vera-Donoso CD, Lujan S, Gomez L, Ruiz JL, Jimenez Cruz JF. Cutaneous horn in glans penis: a new clinical case. Scand J Urol Nephrol. 2009;43(1):92-3. [Medline].

  19. Nthumba PM. Giant cutaneous horn in an African woman: a case report. J Med Case Reports. December 2007;1:170. [Medline].

  20. Mencia-Gutierrez E, Gutierrez-Diaz E, Redondo-Marcos I, Ricoy JR, Garcia-Torre JP. Cutaneous horns of the eyelid: a clinicopathological study of 48 cases. J Cutan Pathol. Sep 2004;31(8):539-43. [Medline].

  21. Vano-Galvan S, Marques A, Munoz-Zato E, Jaen P. A facial cutaneous horn. Cleve Clin J Med. Feb 2009;76(2):92-5. [Medline].

  22. Uchiyama N, Shindo Y, Saida T. Perforating pilomatricoma. J Cutan Pathol. Aug 1986;13(4):312-8. [Medline].

  23. Yu RC, Pryce DW, Macfarlane AW, Stewart TW. A histopathological study of 643 cutaneous horns. Br J Dermatol. May 1991;124(5):449-52. [Medline].

  24. Mantese SA, Diogo PM, Rocha A, Berbert AL, Ferreira AK, Ferreira TC. Cutaneous horn: a retrospective histopathological study of 222 cases. An Bras Dermatol. Apr 2010;85(2):157-63. [Medline].

 
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A typical presentation of a cutaneous horn on the ear.
An unusually large cutaneous horn extending from the ear.
 
 
 
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