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E-IJD CORRESPONDENCE
Year : 2015  |  Volume : 60  |  Issue : 1  |  Page : 107
Squamous cell carcinoma arising from a giant cutaneous horn: A rare presentation


1 Bangalore Medical College, Bangalore, Karnataka, India
2 Department of General Surgery, Bangalore Medical College, Bangalore, Karnataka, India

Date of Web Publication26-Dec-2014

Correspondence Address:
Budamakuntla Leelavathy
Bangalore Medical College, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.147893

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How to cite this article:
Leelavathy B, Kemparaj T, Sathish S, Khadri SI. Squamous cell carcinoma arising from a giant cutaneous horn: A rare presentation. Indian J Dermatol 2015;60:107

How to cite this URL:
Leelavathy B, Kemparaj T, Sathish S, Khadri SI. Squamous cell carcinoma arising from a giant cutaneous horn: A rare presentation. Indian J Dermatol [serial online] 2015 [cited 2020 Sep 23];60:107. Available from: http://www.e-ijd.org/text.asp?2015/60/1/107/147893


Sir,

Cutaneous horn, or cornu cutaneum, is the clinical terminology for a circumscribed, conical, markedly hyperkeratotic lesion in which the height of the keratotic mass amounts to at least half of its largest diameter. [1] Cutaneous horns are horny plugs or outgrowths that may be caused by various epidermal changes, such as epidermal naevus, viral wart, molluscum contagiosum, keratoacanthoma, seborrheic keratosis, marsupialized trichilemmal cyst and squamous cell carcinoma. The spectrum of cutaneous horns can range from benign to malignancy; in about 20% of patients, squamous cell carcinoma is present at the base of the lesion. Hence this case is being reported to highlight the importance of histopathological examination in every case of a cutaneous horn.

A 62-year-old man presented to us with 6 months history of growth on the left angle of the mouth, which was insidious in onset, initially measuring the size of a pea and progressively increasing in size. There was no history of any other dermatological illness. Local examination revealed a single conical, projection measuring 7 × 3 cm in size, hard in consistency, beginning over the left side of the angle of the mouth, growing downwards and laterally up to the level of upper one-third of the neck; base of the lesion showed crusting and purulent material [[Figure 1]a and b]. Oral cavity did not show any lesion. Systemic examination was normal.
Figure 1: (a) Single conical, projection measuring seven by three centimeters in size, hard in consistency, beginning over the left side of the angle of the mouth, growing downwards and laterally up to the level of upper one-third of the neck; base of the lesion showed crusting and purulent material, (b) Front view

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Routine blood investigations were within normal limits. The lesion was excised and sent for histopathological examination, which showed marked hyperkeratosis, striking acanthosis, elongated bulbous rete ridges, breach in basement membrane with broad-based islands of keratinocytes invading the stroma, numerous keratin pearls seen in the dermis, minimal cytological atypia with lymphocytic infiltrate. The findings were consistent with squamous cell carcinoma of verrucous variant [[Figure 2]a and b].
Figure 2: (a) Low power view (×10) of H and E stain showing marked hyperkeratosis, striking acanthosis, elongated bulbous rete ridges, broad-based islands of keratinocytes invading the stroma, numerous keratin pearls seen in the dermis. (b) High power view (×40) of H and E stain of keratin pearl showing minimal cytological atypia

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Several cases of giant cutaneous horns have been reported. A case of giant cutaneous horn in a 67-year-old man on upper leg that resembled a keratoacanthoma, the histologic examination of which revealed a giant verruca vulgaris was reported. Giant verruca vulgaris is a very rare cause of giant cutaneous horns. [2] Another case of giant cutaneous horn in a young female of five year duration arising from a burn scar from right parietal region measuring 6 × 3 cm in size was reported in an African woman. [3] Another case of giant cutaneous horn measuring 6 × 3 cm size overlying hypertrophic lichen planus over the anterior aspect of the left leg was reported from Mangalore. [4] Another case of a giant cutaneous horn of the nose in an elderly male was reported. [5] As per our literature search, this is the longest measuring cutaneous horn published till date.

 
   References Top

1.
Cockerell CJ, Larsen F. Benign Epidermal Tumors and Proliferations. In: Bolognia JL, Jorizzo Jl, Raphini RP, editors. Dermatology. 2 nd ed. Chapter 112. Haryana, India: Reed Elsevier India Private Limited; 2008. p. 1675-6.  Back to cited text no. 1
    
2.
Wollina U, Schönlebe J. Giant keratoacanthoma-like cutaneous horn of the upper leg: A case report. Acta Dermatovenerol Alp Panonica Adriat 2010;19:29-30.  Back to cited text no. 2
    
3.
Nthumba PM. Giant cutaneous horn in an African woman: A case report. J Med Case Rep 2007;1:170.  Back to cited text no. 3
    
4.
Kumaresan M, Kumar P, Pai MV. Giant cutaneous horn. Indian J Dermatol 2008;53:199-200.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Saraf S. Sebaceous horn: An interesting case. Indian J Dermatol 2007;52:59-60.  Back to cited text no. 5
  Medknow Journal  


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