Cutaneous horns are horn-like projections that occur on the skin. These horns are formed by a build-up of keratin, which is also known as hyperkeratosis. Keratin is the same substance that forms our fingernails. Most horns are benign; however, a small percentage of cutaneous horns are either precancerous or malignant at their base, at the skin’s surface. Lighter skinned people between the ages of 60 and 70 are more likely to develop hyperkeratosis.
Cutaneous horns are not usually painful, but they can become painful at their base. Because cutaneous horns grow out from the skin, they can be easily bumped. When these horns are bumped, trauma to the skin can result in a lesion. Seborrheic keratosis and sebaceous adenoma are examples of benign lesions, and actinic keratosis and sebaceous carcinoma are examples of cancerous lesions that can produce cutaneous horns.
Common places for cutaneous horns to occur
Parts of the body most likely to have hyperkeratosis are the back of the hands, the face, nose and forearms. Most horns are just a few millimeters in height, but some are more than an inch long. Sometimes these conical cutaneous horns or tumors will become very large. Due to their location and their height, cutaneous horns can be accidentally hit. Horns on the ears could be hit when combing the hair, and horns on the back of the hand could be hit accidentally and cause pain at the base of the horn.
Diagnosis and treatment for cutaneous horns
A person with cutaneous horns will need to be diagnosed by a medical professional. A biopsy of the lesion at the base of the horn will need to be done to rule out the presence of cancer cells. If cancer is present, sometimes surgery is all that will be needed. The surgeon will excise the horn with a margin of tissue in the surrounding areas. In some cases, radiation therapy and chemotherapy is needed to prevent the horns from coming back.
Most cases of these conical tumors are noncancerous, but squamous cell carcinoma is present in about 20 percent of the people having these horns. Cutaneous horns can be removed with surgery, but the underlying cause for them may need to be identified and treated. Cryosurgery can be done which destroys the different types of hyperkeratosis. If the horns are not cancerous, surgical removal of the horn from the base of the skin is usually all that is needed.
Cancerous lesions must be classified as squamous cell or basal cell carcinoma. People having these cancerous lesions will need to follow up with their physicians after diagnosis and treatment. Doctors usually follow their patients for an extended period of time look for signs of recurrence of the cancer.
World Journal of Surgical Oncology