Cutaneous Horns - Clinical Manifestations and Treatment

What Is a Cutaneous Horn?

A cutaneous horn is a kind of abnormal growth that occurs on the skin. Keratin, a protein that makes up the epidermis (top layer) of the skin, is the main component of cutaneous horns. Its shape and size might resemble a cone or horn. It resembles an animal’s horn and hence the name.

Physical examination often reveals the lesion, which is typically described as a white or yellow exophytic protrusion (abnormal protrusion from the tissue surface) like an animal horn. Contrary to animal horns, which typically include an osseous cast, cutaneous horns are made entirely of cornified (cell death process in the cell of the skin) and proliferating keratinocytes (cells found in the topmost layer of the skin). Since the cutaneous horns vary widely in color, size, form, and dimensions, medical suspicion should be verified by a histological investigation.

What Is the Epidemiology of Cutaneous Horns?

• Cutaneous horns are mainly seen in older people between the ages of 60 and 80. In the senior population, it is more likely to be malignant or premalignant.

• Males and females have the same prevalence rate for benign lesions of cutaneous horns, but males are more likely to develop premalignant or malignant cutaneous horns.

• The head, neck, and upper extremities are among the places most susceptible to ultraviolet radiation; therefore, lesions, whether benign, premalignant, or malignant, are most frequently seen in these areas. In these frequently sun-exposed regions of the body, wider-based lesions of cutaneous horns are more common.

What Are the Causes of Cutaneous Horns?

The actual etiology of a cutaneous horn is frequently unclear, although sunlight exposure is believed to be a potential contributing factor. Additionally, the presence of viral warts caused by human papillomavirus is considered another potential cause.

What Are the Clinical Manifestations of Cutaneous Horns?

The most common symptom of the cutaneous horn is a development that grows on the surface of the skin. The development might take the shape of a cone, spike, or a big bump. The growth might be a different color or the same color as the skin. The color of the growth can differ and exhibit variations.

1. Appearance:

• A cutaneous horn often appears as a firm and yellow-brown protrusion that may be straight or curved.

• The border around the lesion can be formed by thick skin or normal skin.

• The base of the horn can have different shapes, such as being flat, protruding, or resembling a crater.

• In cases of recurrent injury, the presence of inflammation can be observed.

• Horizontal ridges may be present on the horn's side, giving it the appearance of a terrace or an oyster shell.

2. Size:

• The height of the cutaneous horns is two times the base width.

• The size might show variations from a few millimeters up to several centimeters.

3. Location:

• Cutaneous horns can appear anywhere on the body, although they appear more frequently on parts that are exposed to the sun, particularly the ears, head, forearms, and hands.

• They can also develop on the penis, neck, shoulder, and chest.

• Typically, cutaneous horns occur as a solitary (single) growth, although they can occasionally manifest as multiple growths.

4. Symptoms:

• They are usually asymptomatic but can turn painful due to repeated injury and infection.

What Are the Features Suggestive of Malignancy in Cutaneous Horns?

Malignancy cannot be confirmed based on the clinical features and needs further evaluations and tests for confirmation. However, certain clinical features can alert the patient to consult their doctors and get a proper diagnosis on time to reduce the risks of malignancy.

• Painful lesion.

• Hardening and thickening (induration) at the base of the lesion or the entire lesion.

• A spontaneous and rapid growth in the lesion's size.

• Low height-to-base ratio or a wide base of the lesion.

• The rapid and disorganized growth of cutaneous horns results in the absence of terrace formation.

How Is the Diagnosis for Cutaneous Horns Done?

• The doctor may do a physical examination along with gathering a medical history to identify a cutaneous horn. The majority of cutaneous horns are identified depending on how they appear.

• A biopsy is done after excising the lesion surgically. The horn base must be histologically examined to rule out malignancy because there are no clear-cut clinical characteristics that can separate cutaneous lesions from skin cancer.

What Is the Treatment of Cutaneous Horns?

The best way to handle cutaneous horns is with a multidisciplinary team approach. Dermatologists should be consulted or referred to in the beginning. Clinically, mild cases should be handled in primary care.

1. Surgical removal is the most widely used method for treating cutaneous horns. The treatment approach will also vary depending on whether the growth is determined to be malignant or benign. Recovery time is determined by the kind and size of the cutaneous horns.

2. Other treatment approaches for non-cancerous cutaneous horns are:

• Cryotherapy - Using liquid nitrogen to freeze the growth.

• Laser Therapy - Burning and scraping the growth using lasers. For aesthetic reasons as well as electrocautery, ablative lasers such as carbon dioxide or neodymium-doped yttrium aluminum garnet may be preferred.

3. For a confirmed diagnosis, the sample should be sent for histopathological evaluation after removing it surgically. The subsequent therapy strategy should be chosen depending on the histopathological results due to the variety of underlying causes of cutaneous horns.

4. Treatment options for malignant cutaneous horns include:

• Radiation therapy.

• Chemotherapy.

• Stimulating the immune system by medicines.

• Surgical removal along with the base extension.

What Is the Prognosis of Cutaneous Horns?

The underlying disease process affects the prognosis. Since cutaneous horns are usually benign and painless conditions, surgical removal is recommended for aesthetic reasons. However, if malignancy is suspected, then it has to be addressed first, and thus, a reliable prognosis may only be obtained following a histological examination of the underlying disease. Squamous cell carcinoma (SCC) and actinic keratoses (AK) are the most commonly seen cancerous growth in cutaneous horns.

Conclusion

A cutaneous horn cannot spread to other persons and is not infectious. Cutaneous horns are intriguing and often visually striking skin lesions that warrant medical attention. Timely diagnosis, appropriate treatment, and long-term monitoring are crucial in managing these lesions and ensuring optimal skin health. Counseling on sun protection methods is crucial since the sun-exposed parts are more frequently impacted. For individuals who have a history of extended sun exposure, using sunscreen, looking for shade, avoiding peak UV radiation hours, and wearing sun-protective clothes are crucial pieces of advice. Additionally, it is standard practice to instruct patients on how to undertake monthly self-skin checks and regular exams to guarantee patient education and long-term well-being.