Abstract
Cutaneous Horn of the pinna is a relatively uncommon entity. Most of the cases reported in literature have been caused due to prolonged exposure to sunlight but in this case the cutaneous horn has been caused due to injury to the pinna with wheat sheaf
Cutaneous Horn (Cornu Cutaneum) is a relatively uncommon lesion consisting of projectile, conical, hyperkeratotic nodule which resembles the horn of an animal. It occurs most frequently on the sun exposed parts -namely the face and scalp but it has also been described on hands, penis, eyelids vestibule of nose [1]. We are presenting this case because-
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1.
Cutaneous horn is an uncommon entity
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2.
The cutaneous horn is generally associated with prolonged exposure to sunlight but in this case it occurred following injury to pinna .
Case Report
A 55 year old male farmer presented to the deptt. Of ENT with complaint of horny projection of the left pinna since 2 months. It started with injury to the pinna with wheat sheaf which resulted in a small ulcer. On healing there was hardening of the skin which slowly developed into a small excrescence and progressively increased in size. Local examination showed a horny, greyish, brown projection of roughly 6 cm size arising from the helix of left pinna from a base of 0.5 cm. The base was erythematous (Fig. 1). The rest of pinna was normal. The right ear was normal. No papules or any other skin lesions were seen. Investigations were within normal limits.
The horn was excised under local anaesthesia (Fig. 2). The horn was extending to the cartilage but not involving the cartilage. Primary closure of the wound was done.
The Histopathology revealed marked hyperkeratosis and hyperplasia of squamous epithelium consistent with cutaneous horn (Figs. 3, 4). No evidence of malignancy was seen.
Discussion
The earliest known case of cutaneous horn was noted in 1558 in a Welsh woman. Cutaneous horn is a yellowish, brown keratotic excrescence which is usually solitary and has a length one and half times its greatest diameter [2]. The Pinna because of its exposed location is particularly liable to the deleterious effects of U.V. rays of sunlight and so a common site of this lesion [3]. In a series of 11 cases, majority of cases (4/11) were located on the ear [3].
Prolonged exposure to sunlight has been named as one of the causative factor for cutaneous horns [4]. All the patients in a series of 11 cases had long term exposure to actinic rays and all cases had solar keratosis on their hands and foot [3].
The solitary horns may have different pathologies at their base. More than half of all cutaneous horns lie on benign lesions ranging from simple epidermal neavi, warts, actinic keratosis, seborrhoic keratosis, etc. However, a few may have squamous or basal cell carcinoma at its base. A case of cutaneous horn originating from Kaposi sarcoma and Psoriasis have also been described [5]. In a series of 11 cases, solar keratosis was found in 4, squamous cell carcinoma in 2 cases, actinic keratosis in 2 cases, keratoacanthoma in 2 cases and basal cell carcinoma in 1 case [3]. In a series of 643 cases of cutaneous horns, 39% of lesions were found originating from malignant or pre-malignant lesions(Squamous cell carcinoma, Basal cell carcinoma, Actinic keratosis and 61% from benign lesions [6]. Hence, accurate determination of the disease process at the base is strongly recommended. Histopathological examination of base of every case of cutaneous horn is a must specially in the elderly to look for any malignancy.
The treatment of horn is simple excision with primary repair but if any suspicious area is seen then wide surgical excision should be done.
Recurrences are uncommon.
References
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Yu RC, Pryce DW, Macfarlane AW, Stewart TW (1991) A histopathological study of 643 cutaneous horns. Br J Dermatol 124:449–452
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Purohit, G.N., Agarwal, N. & Agarwal, R. Cutaneous Horn Following Injury to Pinna. Indian J Otolaryngol Head Neck Surg 63 (Suppl 1), 47–48 (2011). https://doi.org/10.1007/s12070-011-0189-7
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DOI: https://doi.org/10.1007/s12070-011-0189-7