Cutaneous horns, also known by the Latin name ''cornu cutaneum'', are unusual

keratin Keratin () is one of a family of structural fibrous proteins also known as ''scleroproteins''. Alpha-keratin (α-keratin) is a type of keratin found in vertebrates. It is the key structural material making up scales, hair, nails, feathers, ho ...

ous skin tumors with the appearance of horns, or sometimes of wood or coral. Formally, this is a clinical diagnosis for a "conical projection above the surface of the skin." They are usually small and localized but can, in very rare cases, be much larger. Although often

benign Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malign ...

, they can also be

malignant Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not s ...

premalignant A precancerous condition is a condition, tumor or lesion involving abnormal cells which are associated with an increased risk of developing into cancer. Clinically, precancerous conditions encompass a variety of abnormal tissues with an increased ...

Signs and symptoms

The lesion at the base of the keratin mound is benign in the majority of cases. Malignancy is present in up to 20% of cases, with

squamous-cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

being the most common type. The incidence of squamous-cell carcinoma increases to 37% when the cutaneous horn is present on the

penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do n ...

. Tenderness at the base of the lesion often suggests the presence of a possible underlying squamous-cell carcinoma. Cornu cutaneum 2

Cause

The cause of cutaneous horns is still unknown, but it is believed that exposure to radiation can trigger the condition. This is evidenced by a higher rate of cases occurring on the face and hands, areas that are often exposed to sunlight. Other cases have reported cutaneous horns arising from burn scars. As with many other wart-like skin conditions, a link to the

HPV Human papillomavirus infection (HPV infection) is caused by a DNA virus from the '' Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and re ...

virus family, especially the HPV-2 subtype has been suggested.

Diagnosis

Cutaneous horn usually arises due to an underlying epidermal lesion, the most common being

verruca vulgaris A plantar wart, or verruca vulgaris, is a wart occurring on the bottom of the foot or toes. Its color is typically similar to that of the skin. Small black dots often occur on the surface. One or more may occur in an area. They may result in pain ...

(wart),

actinic keratosis Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin.Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. . Actinic k ...

(a potentially pre-malignant lesion of dysplastic keratinocytes), or

squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

(a form of skin cancer). These can look essentially identical clinically. The only reliable way to diagnose which type of lesion is present under the horn is to biopsy the lesion and have it microscopically examined by a

pathologist Pathology is the study of the causal, causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when us ...

(or dermatologist).

Treatments

As the horn is composed of

, the same material found in fingernails, the horn can usually be removed with a sterile razor. However, the underlying condition will still need to be treated. Treatments vary, but they can include

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

radiation therapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...

, and

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...

Notable cases

* Zhang Ruifang, aged 101 (as of 2010), living in Linlou Village,

Henan province Henan (; or ; ; alternatively Honan) is a landlocked province of China, in the central part of the country. Henan is often referred to as Zhongyuan or Zhongzhou (), which literally means "central plain" or "midland", although the name is al ...

China China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...

, has grown a cutaneous horn on her forehead, resembling what those who have examined her and her family call ''"Devil's Horns."'' Notably, this growth has expanded to reach a total of 6 centimeters in length. Another is forming on the opposite side of her forehead. * Liang Xiuzhen, aged 87 (as of 2015) living in Guiyan village in Ziyang City,

Sichuan Sichuan (; zh, c=, labels=no, ; zh, p=Sìchuān; alternatively romanized as Szechuan or Szechwan; formerly also referred to as "West China" or "Western China" by Protestant missions) is a province in Southwest China occupying most of the ...

province, China, grew a 13 cm (5.1") pointed horn from her forehead, earning her the nickname "Unicorn Woman". * Huang Yuanfan, aged 84 (living in Ziyuan, China). * Shyam Lal Yadav, aged 74 (living in

Madhya Pradesh Madhya Pradesh (, ; meaning 'central province') is a state in central India. Its capital is Bhopal, and the largest city is Indore, with Jabalpur, Ujjain, Gwalior, Sagar, and Rewa being the other major cities. Madhya Pradesh is the seco ...

, India) grew a 4 inch horn after an accident, he later got it surgically removed. * Madame Dimanche, called Widow Sunday, a French woman living in

Paris Paris () is the capital and most populous city of France, with an estimated population of 2,165,423 residents in 2019 in an area of more than 105 km² (41 sq mi), making it the 30th most densely populated city in the world in 2020. S ...

in the early 19th century, grew a 24.9 cm (9.8") horn from her

forehead In human anatomy, the forehead is an area of the head bounded by three features, two of the skull and one of the scalp. The top of the forehead is marked by the hairline, the edge of the area where hair on the scalp grows. The bottom of the fore ...

in six years from the age of 76 before it was successfully removed by French

surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

Br. Joseph Souberbeille (1754–1846). A wax model of her head is on display at the

Mütter Museum The Mütter Museum is a medical museum located in the Center City area of Philadelphia, Pennsylvania. It contains a collection of anatomical and pathological specimens, wax models, and antique medical equipment. The museum is part of The Coll ...

, The College of Physicians of Philadelphia, US.The Mütter Museum
Corkscrew-balloon.com (2003-05-26). Retrieved on 2010-10-27. *The

Shope papilloma virus The Shope papilloma virus (SPV), also known as cottontail rabbit papilloma virus (CRPV) or ''Kappapapillomavirus 2'', is a papillomavirus which infects certain leporids, causing keratinous carcinomas resembling horns, typically on or near the ...

can cause rabbits to grow horns. This may have been the source of myths such as the

Wolpertinger In German folklore, a wolpertinger (also called wolperdinger or woiperdinger) is an animal said to inhabit the alpine forests of Bavaria and Baden-Württemberg in southern Germany. Description It has a body comprising various animal parts – ...

and the

Jackalope The jackalope is a mythical animal of North American folklore described as a jackrabbit with antelope horns. The word ''jackalope'' is a portmanteau of ''jackrabbit'' and ''antelope''. Many jackalope taxidermy mounts, including the original, ...

. File:François Trouille, a man with a horn growing from his head. Wellcome V0007282EL.jpg, François Trouille File:Ulisse aldrovandi, monstrorum historia, per nicola tebaldini, bologna 1642, 058 uomo cornuto.jpg, François Trouille, in the works of

Ulisse Aldrovandi Ulisse Aldrovandi (11 September 1522 – 4 May 1605) was an Italian naturalist, the moving force behind Bologna's botanical garden, one of the first in Europe. Carl Linnaeus and the comte de Buffon reckoned him the father of natural history st ...

File:Mary Davis, a woman with horns, aged 74. Mezzotint. Wellcome V0007048.jpg, Mary Davis, age 74, of

Chester Chester is a cathedral city and the county town of Cheshire, England. It is located on the River Dee, close to the English–Welsh border. With a population of 79,645 in 2011,"2011 Census results: People and Population Profile: Chester Loca ...

File:Elizabeth French, a woman with horns. Aquatint. Wellcome V0007092ER.jpg, Elizabeth French of

Tenterden Tenterden is a town in the borough of Ashford in Kent, England. It stands on the edge of the remnant forest the Weald, overlooking the valley of the River Rother. It was a member of the Cinque Ports Confederation. Its riverside today is not ...

File:Horny tumors.jpg, Capt. Levi Becket of

Atlantic City, New Jersey Atlantic City, often known by its initials A.C., is a coastal resort city in Atlantic County, New Jersey, United States. The city is known for its casinos, boardwalk, and beaches. In 2020, the city had a population of 38,497.

, 1870

References

External links

{{DEFAULTSORT:Cutaneous Horn Epidermal nevi, neoplasms, and cysts