Cutaneous horn: causes, symptoms, diagnosis, treatment

A cutaneous horn is characterized by the appearance of a dense horny mass protruding above the skin surface, often cylindrical in shape. It most often develops in older people. Recently, the term "cutaneous horn" has been considered a collective one, since it can develop in various processes, including benign tumors such as warts, keratopapillomas, keratoacanthomas. But most often it is observed in actinic keratosis and the initial stages of squamous cell carcinoma. In this regard, in each case of cutaneous horn, a thorough histological examination is required.

Causes and pathogenesis of cutaneous horn. Cutaneous horn occurs due to epidermal proliferation, especially against the background of senile keratosis, common wart and keratoacanthoma. Among the provoking factors are microtrauma, insolation, viral infections, etc.

Symptoms of cutaneous horn. Limited growths of horny masses resembling animal horns, mostly conical in shape, usually straight, yellowish-brown or dark in color, dense or firm in consistency. The surface is smooth or uneven with multiple furrows. Inflammatory phenomena are detected only in the immediate vicinity of the base of the horn in the form of a narrow erythematous rim. Horny neoplasms can reach very large sizes, less often they are small in length. Growths occupy larger areas on the surface, but even in these cases the size of the apex is significantly narrower than the base. The height of the cutaneous horn can serve as a prognostic sign to a certain extent. Thus, a cutaneous horn, the size of which does not exceed one centimeter, usually develops against the background of basiloma and senile keratoma. At the base of a larger cutaneous horn, seborrheic warts, keratoacanthoma, keratinizing papilloma are histologically detected. On the red border of the lips, the height of the cutaneous horn usually does not exceed 0.5-1 cm. The lower lip is affected much more often, often with various pathological processes (lupus erythematosus and tuberculous lupus, leukoplakia, etc.).

The cutaneous horn is usually single, multiple neoplasms are rare. It develops somewhat more often in women, especially in older women, and is located mainly on the face (ears, cheeks) and scalp. Rarely, the cutaneous horn is located on mucous and semi-mucous membranes. The course and prognosis depend on the dermatosis against which the cutaneous horn developed. Cancer is most often detected in cases of cutaneous horn that developed against the background of senile keratosis, not counting those cases where it arose in the tumor zone.

Histopathology. Marked hyperkeratosis and papillomatosis are observed; at the base, as indicated, there may be a variety of processes - precancerous, malignant and benign tumors, infectious, trauma-induced, etc.

Pathomorphology. There is a pronounced hyperkeratosis with the formation of layered masses, in the area of the base - acanthosis with hypertrophy of the granular layer. In malignancy in acanthotic growths, one can see cell polymorphism, similar to that in actinic keratosis, multiple mitoses, including pathological ones.

Differential diagnosis. It is necessary to differentiate cutaneous horn from warts, calluses, fibromas, angiokeratoma limited neviformis, warty nevi, and warty psoriasis.

Treatment of cutaneous horn. Surgical excision is performed.

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