A cutaneous horn is a hard, conical, dense, hyperkeratotic cutaneous lesion. There were accounts of giant cutaneous horns in the sixteenth and seventeenth centuries which might have been due to lack of knowledge and lack of health facilities. Numerous natural and supernatural theories have been discussed in history regarding their etiology. The late eighteenth century marks the characterization of the disease as a medical disorder by surgeons Everard Home and his brother-in-law John Hunter in London [
A 74-year-old farmer presented with a cutaneous projection over medial surface of his right pinna for 1 year. It started as a small cutaneous projection which was progressively enlarging. He denied any history of pain but had discomfort over the pinna. There was no history of discharge from the projection. There was no history of hearing loss, tinnitus. There was no history of similar lesions or any other mass in other parts of his body. He did not give any history of weight loss and loss of appetite. There was no history of significant medical illness, trauma to ear or surgery in the past. He was a nonsmoker and did not drink alcohol. He did not give history of similar lesions in any of his family members. On examination, his vitals were within normal limits. Systemic examination revealed no abnormality. On examination of the lesion, there was a woody hard, nontender cutaneous projection, measuring ∼8 × 5 × 3cm3 over the medial surface of right pinna (Figure
(a) Giant cutaneous horn over the medial aspect of right pinna. (b) Histopathological slide of the surgical specimen.
Cutaneous horn, also known as cornu cutaneum, is a form of hypertrophic senile keratosis in which the horny layer accumulates and adheres resulting to horn. In around 20% to 25% of cases malignant transformation into squamous cell carcinoma has been found [
Early diagnosis and treatment is mandatory to prevent the risk of transformation to malignancy and the psychosocial stress owing to the bizarre presentation. Surgical excision remains the treatment of choice in most cases [
Giant cutaneous horns might present as small asymptomatic lesions. Despite the fact that majority of lesions are benign, the risk of malignant transformation should not be ignored. The standard treatment should be excision biopsy with adequate margins. We have reported our case owing to its typical presentation, a close resemblance of an animal horn and its association with malignancy. Very few cases of “giant cutaneous horn” have been found in literature. We have tried to keep our focus over the unavoidable risk of malignancy which should be addressed on time to avoid physical and psychosocial stress to the patient and the attending family members.
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Written informed consent to publish his clinical details and images was obtained from the patient.
The authors declare that they have no conflicts of interest.
SS and TP were involved in case review, data collection, preparation of the manuscript, and patient care, while TRB was involved in case review, preparation of the manuscript, and data analysis. All authors read and approved the final manuscript.
The authors would like to acknowledge their patient for granting us permission for article publication.