A histopathological study of 643 cutaneous horns

Abstract

A retrospective study of 643 cutaneous horns examined in our department between 1970 and 1989 revealed that 38.9% were derived from malignant or premalignant epidermal lesions, and 61.1% from benign lesions. Four main features were associated with premalignant or malignant histopathological change at the base of a cutaneous horn (base pathology). These were: (i) age--the mean age of the patients whose cutaneous horns showed premalignant or malignant base pathology was 8.9 years greater than the mean age of the patients where base pathology was benign (P less than 0.0005); (ii) sex--males were more likely to develop a cutaneous horn with (pre)malignant base pathology (P less than 0.001); (iii) site--over 70% of all (pre)malignant lesions were found on the nose, pinnae, backs of hands, scalp, forearms and the face; a cutaneous horn found at these sites was 2.1 times more likely to have derived from a (pre)malignant base than from any other part of the body (P less than 0.0001); (iv) geometry of the lesion--lesions with a wide base or a low height-to-base ratio were significantly more likely to show (pre)malignant base pathology. Of those solar keratoses giving rise to cutaneous horns, 8.9% also showed histological evidence of change to squamous cell carcinoma (SCC); this figure was not significantly different from the 6.2% of solar keratoses without horns that showed SCC change during the same period (1970-89).

Cutaneous Horn

“…pre-malignant (solar keratosis, Bowens disease, arsenical keratosis) or malignant (squamous cell carcinoma, sebaceous carcinoma, Kaposi's sarcoma) [8]. Yu et al in their study of 643 cases, have reported malignant lesions in 39% patients [3]. Certain risk factors for malignancy have been put forth, viz large size, a wide base relative to height, tenderness at the base, advanced age and the male sex [3].…”

“…Yu et al in their study of 643 cases, have reported malignant lesions in 39% patients [3]. Certain risk factors for malignancy have been put forth, viz large size, a wide base relative to height, tenderness at the base, advanced age and the male sex [3]. Complete excision is the treatment of choice and histopathological examination of the base of the lesion is extremely crucial [8].…”

“…Forearm, cartilaginous portion of the ear, legs, and hands may also be affected [2]. They are thought to result from underlying benign, premalignant or malignant pathology, in 61.1%, 23.2% and 15.7% of cases respectively [3]. Histologic confirmation is necessary to rule out malignant changes.…”

The importance of early diagnosis and treatment of actinic keratosis

“…30 A large retrospective study of 643 cutaneous horn lesions reported that 61.1% were derived from benign lesions and 38.9% from malignant or premalignant lesions; 8.9% showed evidence of change to SCC. 31 Features associated with malignant or premalignant pathology of the base were older patient age (P \.0005) and male gender (P \.001). 31 More than 70% of the high-risk lesions occurred on the nose, ear, back of the hands, scalp, forearm, or face; lesions at these sites were more than twice as likely to show malignant or premalignant base pathology as were lesions at other body sites (P \.0001).…”

“…31 Features associated with malignant or premalignant pathology of the base were older patient age (P \.0005) and male gender (P \.001). 31 More than 70% of the high-risk lesions occurred on the nose, ear, back of the hands, scalp, forearm, or face; lesions at these sites were more than twice as likely to show malignant or premalignant base pathology as were lesions at other body sites (P \.0001). 31 Lesions with malignant base pathology were more likely to have a wide base or low height-to-base ratio than were benign lesions.…”