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CASE REPORT
Year : 2017  |  Volume : 7  |  Issue : 4  |  Page : 145-148

Giant sebaceous horn on flank: A rare presentation


Department of Surgery, LLRM Medical College, Meerut, Uttar Pradesh, India

Date of Web Publication29-Oct-2018

Correspondence Address:
Dr. Anju Verma
Department of Surgery, LLRM Medical College, Meerut - 250 004, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ais.ais_24_17

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  Abstract 


Sebaceous horn or cutaneous horn, a rare clinical entity, is a dense hyperkeratotic protrusion or growth composed of keratin that projects above the surface of the skin. We report a unique case of a giant sebaceous horn at left flank in a 64-year-old female developed on an old burn scar, which was successfully excised and reconstructed. Histopathological examination confirmed the presence of an underlying cutaneous horn in the setting of verruca vulgaris. Cutaneous horns mostly occur in sun-exposed areas and are typically found on the face and scalp, but may arise from any part of the body. They are thought to result from underlying benign, premalignant, or malignant pathology.

Keywords: Case report, cutaneous horn, sebaceous horn


How to cite this article:
Rathi S, Verma A, Kumar P, Chauhan PK. Giant sebaceous horn on flank: A rare presentation. Arch Int Surg 2017;7:145-8

How to cite this URL:
Rathi S, Verma A, Kumar P, Chauhan PK. Giant sebaceous horn on flank: A rare presentation. Arch Int Surg [serial online] 2017 [cited 2018 Nov 18];7:145-8. Available from: http://www.archintsurg.org/text.asp?2017/7/4/145/244411




  Introduction Top


Cutaneous or sebaceous horn is a relatively uncommon lesion, also known by the Latin name “cornu cutaneum,” which is a descriptive term for a conical, dense surface projection of adherent keratin that resembles an animal's horn but lacks an internal bone. Most have a yellow-white color, and may be straight or curved and twisted, and vary from a few millimeters to several centimeters in length.[1],[2] The underlying process may be benign, premalignant, or malignant with an incidence of 61.1%, 23.2%, and 15.7%, respectively.[3]

Although many cases of cutaneous horns are reported but giant cutaneous horns are much rarer and remain a curiosity. Its occurrence on the flank is rare. The unique feature of this report is that this cutaneous horn arose from a burn scar in a non-sun-exposed area, a site rarely noted for the development of cutaneous horns.


  Case Report Top


A 64-year-old albino female presented with an interesting growth over an old burn scar, she had sustained a burn to the lower abdomen around 30 years back, which was managed conservatively. She presented with a 12-year history of a painless, slowly growing lesion, arising centrally from the burn scar on the left side. An 85 × 70 × 40 mm cutaneous horn arising from an area of hypopigmented scar tissue was noted [Figure 1] and [Figure 2]. The horn had a flower-like shape arising from a single point with a thick base. The cutaneous margins were irregular, rough, and minimally erythematous, and was difficult to conceal.
Figure 1: Giant cutaneous horn arising from left flank

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Figure 2: Close up of well developed Giant cutaneous horn

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The horn and surrounding tissue were resected with a 10-mm margin [Figure 3] and [Figure 4] and reconstructed with partial thickness graft [Figure 5].
Figure 3: Excision of horn with ‘1’cm margin

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Figure 4: Excised specimen

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Figure 5: Successful reconstruction with partial thickness skin graft

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Histopathological examination confirmed the presence of an underlying cutaneous horn in setting of verruca vulgaris [Figure 6]. No evidence of malignancy was found and the patient was satisfied with the reconstruction.
Figure 6: HPE Picture - Cutaneous horn in setting of Verruca Vulgaris

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  Discussion Top


Cutaneous horns arise from the epithelial layer, but it is the underlying cause that is of clinical significance.[4] Classically, the tumor occurs in sun-damaged skin of fair-skinned elderly patients, often on the face, ears, and extremities, and rarely, on the trunk. In the most extensive pathological series, reported by Yu et al., an underlying malignant or premalignant lesion was identified in 38.9% of cases.[2] These malignancies are usually well-differentiated squamous carcinomas, although basal cell carcinoma and metastatic renal cell carcinoma have also been reported.[5] Premalignant causes include actinic keratosis and Bowen's disease. Benign lesions that may result in a cutaneous horn include seborrheic keratosis, histiocytoma, inverted follicular keratosis, molluscum contagiosum, and verruca vulgaris.[6]

Several studies have reported cutanaeous horns in the medical litreature cutaneous horns have been reported in the medical literature, almost entirely among Caucasians from Europe.[1],[2],[3],[4] The rarity of this condition in other races and regions is evidenced from occasional reports from India[7],[8],[9] (Asia) and Sudan[10] (Africa). Bondeson presented an excellent review of cutaneous horns. In Europe and several other countries, these individuals were often treated with superstitions and many enterprising showmen made careers out of exhibiting people with cutaneous horns for money.[1] Yu et al. reported a series of 643 patients over a 10 year period, with 32 new patients annually, while Mencıa-Gutierrez et al. presented 48 patients in Spain with eyelid cutaneous horns over a similar period of time.[4] Histologically, they found 77.1% horns associated with benign pathology at the base of the specimen, 14.6% were premalignant, and 8.3% were caused by malignant skin tumors. Hence, excision biopsy of the lesion and histopathological examination to rule out malignancy is recommended. Malignancies should be excised with appropriate margins and should be evaluated for metastasis. Lymph nodes draining the area of lesion should be examined carefully. Benign lesions do not require any further therapy after the diagnostic biopsy.[11]

Gould and Brodell[12] have reported a giant cutaneous horn associated with verruca vulgaris. Solivan et al.[13] reported a cutaneous horn of the penis associated with squamous cell carcinoma and HPV-16 infections.

Therefore, horns may be considered a relatively common entity among Caucasian populations, and in India till now six cases have been reported with cutaneous horn at various unusual sites,[7],[8],[9],[14],[15] and this case may be the next and probably the first case of giant horn on flank.


  Conclusion Top


Small cutaneous horns are not uncommon, but “giant” horns, such as in our case, are unusual. The management of these lesions is surgical and directed at the underlying lesion. As seen in this case and supported by the literature, we recommend primary excision of such lesions along with reconstruction. The primary lesions associated with cutaneous horns are usually benign but may be premalignant or malignant. Squamous cell carcinoma should always be included in the differential diagnosis as a common cause of this entity mainly when present on the face. The cutaneous horn stimulates both medical interest and social implications for the patient. Its early diagnosis and proper management can be a remedy for both social stigmata and underlying premalignant or malignant condition.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bondeson J. Everard Home, John Hunter and cutaneous horns: A historical review. Am J Dermatopathol 2001;23:362-9.  Back to cited text no. 1
    
2.
Michal M, Bisceglia M, Di Mattia A, Requena L, Fanburg-Smith JC, Mukensnabl P, et al. Gigantic cutaneous horns of the scalp: Lesions with a gross similarity to the horns of animals: A report of four cases. Am J Surg Pathol 2002;26:789-94.  Back to cited text no. 2
    
3.
Yu RC, Pryce DW, Macfarlane AW, Stewart TW. A histopathological study of 643 cutaneous horns. Br J Dermatol 1991;124:449-52.  Back to cited text no. 3
    
4.
Mencia-Gutierrez E, Gutierrez-Dias E, Redondo-Marcos I, Ricoy JR, García-Torre JP. Cutaneous horns of the eyelid: A clinicopathological study of 48 patients. J Cutan Pathol 2004;31:539-43.  Back to cited text no. 4
    
5.
Copcu E, Sivrioglu N, Culhaci N. Cutaneous horns, are these lesions as innocent as they appear to be? World J Surg Oncol 2004;2:18.  Back to cited text no. 5
    
6.
Leppard W, Loungani R, Saylors B, Delaney K. Mythology to reality: Case report of a giant cutaneous horn of the scalp in an African American female. J Plast Reconstr Aesthet Surg 2014;67:22-4.  Back to cited text no. 6
    
7.
Chakraborty AN. A case of cutaneous horn. Br J Dermatol 1951;63:323.  Back to cited text no. 7
    
8.
Rekha A, Ravi A. Cornu cutaneum-cutaneous horn on the penis. Indian J Surg 2004;66:296-7.  Back to cited text no. 8
    
9.
Tauro LF, Martis JJF, John SK, Kumar KP. Cornu cutaneum at an unusual site. Indian J Plast Surg 2006;39:76-8.  Back to cited text no. 9
  [Full text]  
10.
Bashir JHH. Pachyonychia congenita type 1, with cutaneous horn: A single case report. Sudan J Dermatol 2005;3:37-42.  Back to cited text no. 10
    
11.
Cockerell CJ, Silvis N. Cutaneous horn. In: Taylor RS, Butler DF, Chan EF, Quirk C, James WD, Kligman AM, editors. e-Medicine specialties>Dermatology>Benign Neoplasm. e-Medicine; 2005. pp 1-6.  Back to cited text no. 11
    
12.
Gould JW, Brodell RT. Giant cutaneous horn associated with verruca vulgaris. Cutis 1999;64:111-2.  Back to cited text no. 12
    
13.
Solivan GA, Smith KJ, James WD. Cutaneous horn of the penis: Its association with squamous cell carcinoma and HPV-16 infections. J Am Acad Dermatol 1990;23:969-72.  Back to cited text no. 13
    
14.
Kumar S, Bijalwan P, Saini SK. Carcinoma buccal mucosa underlying a giant cutaneous horn: A case report and review of the literature. Case Rep Oncol Med 2014;2014:518372.  Back to cited text no. 14
    
15.
Chowdhury J, Kumar P, Gharami RC. Multiple cutaneous horns due to discoid lupus erythematosus. Indian J Dermatol Venereol Leprol 2014;80:461-2.  Back to cited text no. 15
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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