BACKGROUND: Cutaneous horn is a morphological designation for a protuberant mass of keratin that resembles the horn of an animal. This reaction pattern is often seen in the background of a variety of primary diseases such as the benign, premalignant, or malignant tumors, and can mask numerous conditions. OBJECTIVE: The purpose of this study was to investigate clinical and histopathological features of cutaneous horns, especially focusing on the underlying diseases. METHOD: We reviewed the medical records and biopsy specimens of 72 cases of cutaneous horns which were diagnosed between January 1991 and July 2004 in 8 hospitals under the charge of Catholic Medical Centers. RESULTS: We compiled clinical data and histologic information on the 72 cases of cutaneous horns as follows: 1. The mean age at diagnosis was 54.3 years, and 69.7% of the patients were over 50 years old. Cutaneous horn developed predominantly in female, as the sex ratio of 1: 1.2. 2. The disease duration did not exceed 1 year in 55.5% of patients. Most patients were asymptomatic, but 11.6% and 15.9% of patients complained of pruritus and pain, respectively. The lesions were usually solitary. 3. Cutaneous horns occurred on the face and neck, trunk, and extremities in 73.6%, 12.5%, and 13.9% of cases respectively, and cheeks, neck, scalp and hands were found to be commonly involved. 4. Histopathologically, 79.2% of cutaneous horns were associated with benign specimens at the base pathology, 15.3% were premalignant, and 5.6% were caused by malignant skin disease. With the benign pathological cases, common lesion were viral warts, and in premalignant cases, actinic keratosis. The malignant lesions were found to consist of squamous cell carcinoma and basal cell carcinoma. 5. Four main features were associated with premalignant or malignant histopathological changes at the base of the cutaneous horns. These were older age, female sex, shorter duration of illness, accompanied pain. CONCLUSION: Cutaneous horn is the term given to a protrusion of keratinized material on the skin, and is often found to arise on sun-exposed skin in elderly men. It may be derived from a benign, premalignant, or malignant lesion. Benign lesions were found to occupy most of the base pathology in Korea. However, because of the possibility of masking malignant lesions, sufficient specimens from the base of lesions should be carefully obtained.
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