Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Apr 30;3(2):3-7.
doi: 10.5826/dpc.0302a02. Print 2013 Apr.

Cutaneous horns: clues to invasive squamous cell carcinoma being present in the horn base

John Pyne  1 , Devendra Sapkota, Jian Cheng Wong
Affiliations

Cutaneous horns: clues to invasive squamous cell carcinoma being present in the horn base

John Pyne et al. Dermatol Pract Concept. .

Abstract

Background: Cutaneous horns usually develop on a keratinocytic base with the histopathology on a spectrum ranging from benign keratosis through to invasive squamous cell carcinoma (SCC). Some features of horns are easily identified using dermatoscopy.

Objective: To investigate if specific clinical or dermatoscopy features of horns correlate with the histopathology in the base of the horn.

Methods: Consecutive horn cases (n=163) were assessed prospectively in vivo for horn height, terrace morphology and base erythema using a Heine Delta 20 dermatoscope. Cases with potentially confounding influences were excluded. A history of horn pain or pain on palpation was also recorded.

Results: Benign keratosis (n = 49), actinic keratosis (n = 21), SCC in situ (n = 37) and invasive SCC (n = 56) were recorded. An invasive SCC presenting as a horn as most likely to have a height less than the base diameter, 66% (37/56). Compared to the other study entities, invasive SCC tends to have less terrace morphology (P<0.05), a higher incidence of base erythema (P<0.05) and more pain (P<0.01).

Limitations: Data categories did not include anatomic site or horn growth rates. Excision selection bias favored the incidence of invasive SCC.

Conclusions: Horns presenting on an invasive SCC base are more likely to have a height less than the diameter of the base, not to have terrace morphology, to have an erythematous base and to be painful.

Keywords: cutaneous horn; pain; squamous cell carcinoma.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
(A) Dermatoscopy demonstrating terrace morphology on a horn over benign keratosis. The horn height is greater than the base diameter, terrace morphology is present, no base erythema is present, and this horn was not painful. (B) Histopathology of the same horn as Figure 1A, hematoxylin and eosin stain. Orderly orthohyperkeratosis is present (arrow). [Copyright: ©2013 Pyne et al.]
Figure 1.
Figure 1.
(A) Dermatoscopy demonstrating terrace morphology on a horn over benign keratosis. The horn height is greater than the base diameter, terrace morphology is present, no base erythema is present, and this horn was not painful. (B) Histopathology of the same horn as Figure 1A, hematoxylin and eosin stain. Orderly orthohyperkeratosis is present (arrow). [Copyright: ©2013 Pyne et al.]
Figure 2.
Figure 2.
(A) Dermatoscopy of a horn with an invasive SCC base on the ear. The horn height is less than the base diameter, no terrace morphology is present, base erythema is present and this horn was painful. (B) Histopathology, same lesion as Figure 2A, hematoxylin and eosin stain. [Copyright: ©2013 Pyne et al.]
Figure 2.
Figure 2.
(A) Dermatoscopy of a horn with an invasive SCC base on the ear. The horn height is less than the base diameter, no terrace morphology is present, base erythema is present and this horn was painful. (B) Histopathology, same lesion as Figure 2A, hematoxylin and eosin stain. [Copyright: ©2013 Pyne et al.]
Figure 3.
Figure 3.
Height of the horn. The relative height of the horn compared to the base diameter. [Copyright: ©2013 Pyne et al.]
Figure 4.
Figure 4.
Presence of terrace morphology. [Copyright: ©2013 Pyne et al.]
Figure 5.
Figure 5.
Presence of erythema in the horn base. [Copyright: ©2013 Pyne et al.]
Figure 6.
Figure 6.
History of horn pain and or pain on palpation. [Copyright: ©2013 Pyne et al.]
See this image and copyright information in PMC

References

    1. Mantese SA, Diogo PM, Rocha A, Berbert AL, Ferreira AK, Ferreira TC. Cutaneous horn: a retrospective histopathological study of 222 cases. An Bras Dermatol. 2010;85(2):157–63. - PubMed
    1. Yu RC, Pryce DW, Macfarlane AW, Stewart TW. A histopathological study of 643 cutaneous horns. Br J Dermatol. 1991;124(5):449–52. - PubMed
    1. Copcu E, Sivrioglu N, Culhaci N. Cutaneous horns: are these lesions as innocent as they seem to be? World J Surg Oncol. 2004;3(2):18. - PMC - PubMed
    1. Mencia-Gutierrez, Gutierrez-Diaz E, Redondo-Marcos I, Ricoy JR, Garcia-Torre JP. Cutaneous horns of the eyelid: a clinicopathological study of 48 cases. J Cutan Pathol. 2004;31(8):539–43. - PubMed
    1. Yang JH, Kim DH, Lee JS, et al. A case of cutaneous horn originating from keratoacanthoma. Ann Dermatol. 2011;23(1):89–91. - PMC - PubMed