Year : 2007 | Volume
: 52 | Issue : 1 | Page : 59--60
Sebaceous horn: An interesting case
NMC SP. Hospital, AL Nahada, Dubai, United Arab Emirates
NMC SP. Hospital, AL Nahada, Dubai
United Arab Emirates
Sebaceous horn or cutaneous horn of the nose is a rare clinical entity. A case of a giant sebaceous horn of the nose presenting in an elderly male, which was successfully excised and reconstructed is reported.
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Saraf S. Sebaceous horn: An interesting case.Indian J Dermatol 2007;52:59-60
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Saraf S. Sebaceous horn: An interesting case. Indian J Dermatol [serial online] 2007 [cited 2020 Dec 1 ];52:59-60
Available from: https://www.e-ijd.org/text.asp?2007/52/1/59/31929
Cutaneous horn ( cornu cutaneum ) is a relatively uncommon lesion consisting of a projectile, conical, dense, hyperkeratotic nodule, which resembles the horn of an animal. The horn is composed of compacted keratin. Cutaneous horns most frequently occur in sun-exposed parts and are typically found on the face and scalp, but may also occur on the hands, penis, eyelids, nose, chest, neck and shoulder. The cutaneous horns are usually benign, however, malignant or premalignant lesions might be associated with it. Because of their malignant potential, the lesions must always be considered for histopathological evaluation.
A 92-year-old male presented with a raised, painless growth over the tip of nose of more than six years duration. The clinical examination demonstrated a cone-shaped keratotic cutaneous horn [Figure 1]. After careful and detailed physical examinations the lesion was excised and reconstructed with lateral nasal flap (Miter flap) with satisfactory result [Figure 2]. Specimen was evaluated microscopically. Microscopically the horn consisted of a mixture of squamous epithelial cells and tricholemmal keratinized debris. The patient had history of long-term sun exposure due to farming activities and had solar keratosis on face and extremities. The follow-up was uneventful without signs of recurrence.
A cutaneous horn ( cornu cutaneum ) is a protrusion from the skin consisting of cornified material resembling an animal horn in miniature. However, the animal horns are composed of superficial hyperkeratotic epidermis, dermis with centrally positioned bone. No such well-formed bone is observed in the human horns. The earliest well-documented case of cornu cutaneum from London in 1588 is of Mrs. Margaret Gryffith, an elderly Welsh woman. However, earliest observations on cutaneous horns in humans were described by the Everard Home in 1791. Farris from Italy first described the well-documented case report with adequate histology of gigantic horn in a man. These horns may arise from a variety of benign, premalignant or malignant epidermal lesions. Most commonly, they are single and arise from a seborrheic keratosis lesion. According to a largest study by Yu et al , 61% of cutaneous horns were derived from benign lesions and 39% were derived from malignant or premalignant epidermal lesions. Two other larger studies on cutaneous horn also showed that 23-37% of horns were associated with actinic keratosis or Bowen's disease and another 16-20% with malignant lesions., The important consideration in these cases is not the horn, but the underlying pathology which may be benign (seborrheic keratosis, viral warts, histiocytoma, inverted follicular keratosis, verrucous epidermal nevus, molluscum contagiosum, etc.), premalignant (solar keratosis, arsenical keratosis, Bowen's disease) or malignant (squamous cell carcinoma, rarely, basal cell carcinoma, metastatic renal carcinoma, granular cell tumor, sebaceous carcinoma or Kaposi's sarcoma. Histopathological examination, specially of the base of the lesion,. is necessary to rule out associated malignancy and full excision and reconstruction is the treatment of choice.
The cutaneous horns are predominantly benign lesions; however possibility of malignant potential should always be kept in mind.
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