Introduction
The cutaneous horn is a keratin nodule that protrudes from the skin's surface of the nipple. The cause of the extreme keratin retention is still unknown. A cutaneous condition typically accompanies the presence of cutaneous horns, frequently a malignant one. Sunlight radiation exposure could be one of the causes. Possessing viral warts brought on by the human papillomavirus is another potential factor. The appearance of skin cancer or precancerous skin lesions is thought to cause roughly half of the cutaneous horns. To identify a cutaneous horn, there is a need for a thorough physical examination is required along with the relevant medical history.
What Is the Cutaneous Horn of the Nipple?
The cutaneous horn of the nipple is a funnel-shaped growth that grows out of a red base on the skin. It is a horn-shaped protrusion from the skin made of cornified material known as a cutaneous horn (cornu cutaneum). Numerous benign or malignant epidermal lesions can give rise to these horns. It is made of keratin that has been compressed (the same protein in nails). Although the growth's size and shape might vary greatly, most only measure a few millimeters in length. Surgical excision (removal or resection) or treatment known as curettage is frequently used to treat benign (noncancerous) lesions that are the root cause of skin horns. In this medical treatment, tissue is removed by scraping or scooping.
What Is the Etiology of a Cutaneous Horn of the Nipple?
Squamous cell carcinoma typically characterizes malignant lesions around the base of the horn, while basal cell carcinoma has also been noted. The leading cause of these precipitations is UV (ultraviolet) light. Paget disease of the breast, sebaceous adenoma, and granular cell tumor are uncommon malignancies near the base. Actinic keratosis, a premalignant lesion, is frequently discovered at the base. The most common infectious etiology caused by the human papillomavirus is verruca vulgaris. Occasionally, a cutaneous horn has developed in the poxvirus group's Molluscum contagiosum. Leishmaniasis is the only other infectious cause to date. Seborrheic keratosis, epidermal nevi, trichilemmal cysts, trichilemmomas, prurigo nodules, and intradermal nevi are some common benign idiopathic causes.
What Is the Appearance of a Cutaneous Horn of the Nipple?
The thin base of the cutaneous horn suggests that it was benign. Still, a histological examination is required to rule out the possibility of pre-invasive intraepithelial dysplasia (abnormality of cells) or skin squamous cell carcinoma. Instead, it appeared to be a thick, elongated keratinized tumor attached to the skin by a thin layer of typical pink or red skin. There is usually no sign of a pre-invasive skin lesion nearby.
What Are the Signs and Symptoms of a Cutaneous Horn of the Nipple?
Horns on the skin are typically asymptomatic. However, they may experience distress because of their great height. The base may become inflamed. As a result, causing pain. Rapid development is typical in presentations. On the body, cutaneous horns can develop everywhere. The distribution is more common on skin exposed to the sun, particularly on the face, pinna, nose, forearms, and dorsal hands. The scalp and upper face have been the sites of 30 % of instances. They are typically a single lesion. It is a hyperkeratotic papule whose height exceeds the base's breadth by at least 50 percent. A cutaneous horn is typically several millimeters long. Still, they can develop into enormous structures that can reach up to 25 cm in some instances and 36 cm in diameter in historical examples.
How Is a Cutaneous Horn of the Nipple Diagnosed?
Histopathology Reports -
The features seen in a histopathology report are as follows:
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Exophytic lesion.
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Epidermal hyperplasia.
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Papillomatosis.
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Hyperkeratosis.
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Parakeratosis.
It was linked to an HPV (human papilloma virus) infection-related viral cytopathogenic impact and the existence of oocytes.
Polymerase Chain Reaction -
The tissue is confirmed for the presence or absence of any signs of HPV infection through a polymerase chain reaction.
What Is the Management of a Cutaneous Horn of the Nipple?
Diagnostic Biopsy or Surgery -
The base lesion type determines the recommended treatment course. It is crucial to take a biopsy of the lesion that includes the base of the horn to rule out cancer. The biopsy serves as both a diagnostic tool and a treatment option for benign lesions at the base of the horn. Malignancies should be removed with the proper margins. Patients with underlying squamous cell carcinoma who have horns should also be examined for metastases.
Cryosurgery -
The first-line treatment for actinic keratosis, verruca vulgaris, and molluscum contagiosum is local destruction by cryosurgery. After the diagnostic biopsy, benign lesions do not need any additional treatment.
What Is the Complication of a Cutaneous Horn of the Nipple?
A damaged cutaneous horn may experience pain and irritation. Therefore, when a cutaneous horn initially forms, it is crucial to call or see the healthcare provider because it could indicate malignancy. The complications of a cutaneous horn of the nipple include the following:
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New cutaneous horn.
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Pain and inflammation.
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Redness or bleeding around it.
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Rapid growth.
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Hardening skin at the horn's base.
What Is the Differential Diagnosis of a Cutaneous Horn of the Nipple?
A cutaneous horn can only be diagnosed differentially histologically. The differential diagnosis is as follows:
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Hypertrophic actinic keratosis.
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Bowen's disease.
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Invasive cancer.
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Hyperkeratotic seborrheic keratosis.
Conclusion
A cutaneous horn of the nipple cannot spread to other persons and is not contagious. It is a growth on the skin which may seem like a horn, cone, spike, or significant bump. Cutaneous horns typically appear on body parts exposed to the sun and are more prevalent in older adults. A cutaneous horn on the skin should be examined by a medical professional as soon as possible because it could be cancerous or an indication of skin cancer. The majority of cutaneous horns are identified depending on how they appear. There might also be the need to perform a biopsy, during which the entire horn will be removed and sent to the lab for microscopic examination. This aids in diagnosing the growth and detecting skin cancer, if any. Removal is the most popular method of treating cutaneous horns. The course of therapy will also depend on whether the tumor is malignant. The recovery period will depend on the type and size of the growth.
