|Year : 2017 | Volume
| Issue : 4 | Page : 145-148
Giant sebaceous horn on flank: A rare presentation
Sudheer Rathi, Anju Verma, Pradeep Kumar, Prashant K Chauhan
Department of Surgery, LLRM Medical College, Meerut, Uttar Pradesh, India
|Date of Web Publication||29-Oct-2018|
Dr. Anju Verma
Department of Surgery, LLRM Medical College, Meerut - 250 004, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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., The underlying process may be benign, premalignant, or malignant with an incidence of 61.1%, 23.2%, and 15.7%, respectively.
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|| |
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.
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].
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.
| Discussion|| |
Cutaneous horns arise from the epithelial layer, but it is the underlying cause that is of clinical significance. 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. These malignancies are usually well-differentiated squamous carcinomas, although basal cell carcinoma and metastatic renal cell carcinoma have also been reported. 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.
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.,,, The rarity of this condition in other races and regions is evidenced from occasional reports from India,, (Asia) and Sudan (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. 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. 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.
Gould and Brodell have reported a giant cutaneous horn associated with verruca vulgaris. Solivan et al. 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,,,,, and this case may be the next and probably the first case of giant horn on flank.
| Conclusion|| |
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.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]