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Giant cutaneous horns
*For correspondence: chatterjee.gobinda@rediffmail.com
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This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
A 52 yr old farmer presented to the outpatient department of Dermatology, (IPGME&R) and SSKM Hospital, Kolkata, India in February 2014, with slowly increasing two horn like projections over the mid-chest since last six years. He also complained of mild pain at the base for the last four months. The lesion appeared de novo on normal looking skin, and was asymptomatic. On examination, two woody hard keratotic protuberant masses, one measuring around 12 × 3 cm and another 10 × 2.5 cm in size originating from a broad base were present over mid central chest with erosion and crust at the base (Fig. 1). There was no lymphadenopathy. Routine investigations and chest X-ray were normal. A histopathology with haematoxylin and eosin stain (H & E) from the base revealed epidermal hyperkeratosis, acanthosis and papillomatosis with disorganised atypical keratinocytes in stratum malpighii arranged in windblown fashion suggestive of underlying Bowen's disease (Figs 2 & 3). The final diagnosis was cutaneous horns originating from Bowen's disease. The patient was referred to the Surgery department for further management, but did not turn up for follow up after surgery.
- Two cutaneous horns originating from necrotic and eroded base over the mid central chest (arrows).
- Photomicrograph showing a hyperplastic epidermis with windblown appearance (arrows). (H and E, ×10).
- Photomicrograph showing cellular atypia with loss of polarity (arrows). (H and E, ×40).
A cutaneous horn is a conical projection of hard hyperkeratotic protuberant mass composed of compact keratin. These are usually <1 cm in length, but may rarely assume giant size. Although usually single, multiple horns may occur. Cutaneous horn has been described with underlying benign and malignant conditions; among them, squamous cell carcinoma is the most common.
