Cutaneous Horn

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cutaneous horn picture
Cutaneous horn

What is a Cutaneous Horn?

Cutaneous horn or Cornu Cutaneum is a development of a skin lesion that is conical in projection or a cone-shaped bulge that surfaces above the skin. Cutaneous horn is also called cornu cutaneum, a Latin reference for horn structure, because of its appearance. A common description of the skin problem is its high comparison to a miniature horn. The skin condition can be of harm to the affected, as statistic reports portray.

In about 40% of cutaneous horns accounted, actinic keratosis is linked to its development, meaning there is a clear representation of a precancerous lesion. The cutaneous horns are said to overlie the cancerous skin. Malignancy is likely possible when a tender sensation at the base of the cutaneous horn is felt. However, in most cases, no clinical features present reliable support for it to be benign or malignant. Further tests are, however, essential to rule out possible malignancy.

This skin condition is said to affect people with increasing age. Those who are 60 to 70 years of age are at most risk for developing cutaneous horn. Fair-skinned individuals are also at risk for cutaneous horn development. The individuals mentioned become prone the more when they have a clear history of considerable exposure to sun and UV rays. In order to diagnose the condition, a skin biopsy is performed. A specimen is collected from a simple shave biopsy procedure.

Characteristics of Cutaneous Horn

The usual affectation of cutaneous horn is the sun-exposed areas of the body. This places the frequently sun-exposed skin a known risk, especially when a person is fair-skinned. The usual body areas affected are the face, pinna (ear), nose, arms, and dorsal hands. The following are the enumerated characteristics of cutaneous horn:

  1. There is an overgrowth and thickening of the skin, which is in a horn-like structure. The cutaneous horn is a protuberance of the skin which has a height greater than half of the base width.
  2. The cutaneous horns, as reported, are mostly asymptomatic. However, when the case presents excessive length or height of the horn, a greater tendency of trauma results which ends to discomfort.
  3. Inflammation of the base area is likely and may lead to further tenderness. There are some cases where development and growth of cutaneous horn becomes rapid resulting to pain.

Cutaneous Horn Pictures

Picture 1 : funnel-shaped growth of Cutaneous Horn that extends from skin base (red)

Image source : © Interactive Medical Media

Wart (verruca) with a cutaneous horn on the toe

Picture 2 : person has a verruca (wart) with cutaneous horn (made up of hard keratin)

cutaneous horn photo
Cutaneous horn photo

Cutaneous Horn Causes

Cutaneous horns basically develop because of precipitating and predisposing factors. A cutaneous horn develops more frequently to the overly sun-exposed parts of the skin, but some cases also present that those sun-protected skin are also affected.

The mechanism of the cutaneous horn starts from the process of hyerkeratosis, usually to the skin surface affected by a hyperprofilerative lesion. The skin condition can either be benign or malignant in form. Most cases are the development of benign verruca/ verruca vulgaris (common wart) or seborrheic keratosis (benign skin growth). While some, unfortunately, develops to premalignant actinic keratosis.

Premalignant actinic keratosis can cause for an alarm as it indicates near development of skin cancer. A greater number of the reported cases are benign at most, while about 23% to 40% are reported to be malignant. Approximately 20% of the malignant cases are affecting the base part of the cutaneous horn, while 33% of malignant cases are squamous cell carcinoma.

Somehow, the condition is linked to the human papilloma virus, which is a frequent causative agent for infections such as verruca vulgaris. In addition, another virus is involved to the development of cutaneous horn. Poxvirus, molluscum contagiosum, is said to be an occasional causative agent for cutaneous horn.

According to reports, men have been found at risk or have more occurrences of malignant cutaneous horn development at the base lesion. Another risk for cutaneous horn is age; the old-aged individuals as victims of the skin problem. Other risk factors include the following:

  • History of radiation exposure
  • Immunocompromised
  • Artificial tanning beds enthusiasts
  • Works outdoors

Cutaneous Horn Treatment

Treatment for cutaneous horn is primarily a surgical intervention. This is the best and ideal treatment of cutaneous horn as to properly identify for presence of malignancy. Usually, those affected of this condition tend to not mind the growth unless they feel any discomfort from it.

One should be health conscious and should report immediately for any form of unusual growth found in the body, especially a superficial one. Cutaneous horn is a medical condition that needs attention when suspected as it entails a risk for malignancy. The following are included in the treatment plan:

  • When your doctor finds an unusual growth from the epidermal skin layer and is horn-like in structure, suspecting it as malignant is safe. This then prompts for a surgical procedure which plays as a diagnostic and therapeutic intervention. Cryosurgery is performed as a first-line form of treatment. Specimen collected is sent for analysis from malignancy. When the cases presents benign results, there shall be no further treatment intervened. However, when malignancy is reported, further tests are done to check for metastasis.
  • When the skin condition is finally diagnosed as malignant, further treatment shall be provided such as chemotherapy. Application of topical chemotherapy is done by the doctor. This is considered as anti-cancer agents that help remove the cutaneous horn in a gradual manner. Initially, redness is observed as the horn is removed from the topical chemotherapy, but eventually, the redness fades away.
  • Further health teachings are provided to patients, especially to those who were diagnosed with squamous cell carcinoma. They are sent for further screenings or follow-up tests to monitor the progress of the newly diagnosed cancer case. During the first 3 years of being diagnosed with cancer, it is recommended that consistent treatment and follow-up is done accordingly.
  • Prevention for further occurrence of cutaneous horn includes skin sun protection. As constant sun exposure is a known factor, you can avoid recurrence of cutaneous horn by applying sunscreen before going out. One is still at risk from UV rays exposure even though the sun is not showing or when it’s cloudy during day time. It is essential to protect oneself from acquiring the risk of cutaneous horn by following this protective intervention.

ICD 9 code

The ICD-9 Code/s or dermatology ICD-9 diagnosis codes include cutaneous horn to be under the Diseases of The Skin and Subcutaneous Tissue (680-709). The ICD-9 Diagnosis Codes 2012 places cutaneous horn as one of Other Diseases of The Skin and Subcutaneous Tissue with code 702.8.

References

http://en.wikipedia.org/wiki/Cutaneous_horn

http://emedicine.medscape.com/article/1056568-overview

http://www.skinsight.com/adult/cutaneousHorn.htm

http://www.livestrong.com/article/10109-treat-cutaneous-horn/

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