What is under the cutaneous horn
The cutaneous horn is always the tip of the iceberg. The horny substance is formed due to the fact that the epidermal cells in this place are intensively keratinized, and exfoliation is impaired. The reason for the increased keratinization is at the base of the growth. In about half of people these are benign lesions, another proportion have precancerous actinic keratosis, and a significant proportion, especially in older people with prolonged sun exposure, have squamous cell carcinoma of the skin. It is impossible even for an experienced doctor to determine this by eye, so the question can only be resolved by histology.
- Viral wart
- Seborrheic keratosis
- Actinic keratosis
- Bowen's disease
- Squamous cell skin cancer
- Less commonly, basal cell carcinoma
What does it look like and where does it appear?
The growth is dense, yellowish-gray or brown, dry, the height can be from several millimeters to several centimeters. The shape can be straight, curved or twisted. Usually there is one horn, less often there are several. Typical localization is areas that have received the sun for years: the face, ears, scalp with baldness, neck, back of the hands and forearms. The horn itself is painless, and people go to the doctor either because of its appearance or when it gets caught on clothing and breaks off and then grows back.
- Dense dry structure without shine
- Color from yellowish to dark brown
- Most often a single element
- Exposed areas of the body
- Can break off and grow back
- The base is the key area for the doctor
Causes and risk factors
The main factor is the accumulated dose of ultraviolet radiation over a lifetime. Therefore, cutaneous horn is more common in older people, those who work outdoors for many years, and those with fair skin that burns easily. The human papillomavirus, which causes warts, plays a role. The risk is higher when the immune system is weakened, including after organ transplantation and when taking immunosuppressants. Additional factors include previous skin trauma, burns and chronic irritation in the same place.
- Long-term solar exposure
- Light skin prone to burns
- Age over 60 years
- Open air work
- Human papillomavirus
- Immunosuppression
- Scars and chronic skin irritation
Diagnostics
The examination begins with an assessment of the base: the doctor looks to see if there is compaction, redness, infiltration, or pain. Dermatoscopy helps to discern the structure at the root of the growth. But only tissue research gives the final answer. Therefore, the standard tactic is to remove the entire formation, along with the base and a small supply of healthy tissue, and send the material for histological examination. Methods that destroy tissue, such as cauterization without removing material, are not suitable for cutaneous horns, because there is nothing to examine after them.
- Examination by a dermatologist
- Dermatoscopy
- Complete excision involving the base
- Histological examination of the removed material
- Examination of the rest of the skin for other lesions
- If cancer is confirmed, consult an oncologist
Treatment and prevention
Treatment is always surgical: the formation is excised under local anesthesia, the wound heals within 1–2 weeks. Further tactics completely depend on the histology result. If the base is benign, observation is sufficient. For actinic keratosis, the doctor discusses treatment for the surrounding sun-damaged skin. When skin cancer is detected, they evaluate whether the formation has been completely removed and decide on additional intervention together with the oncologist. Prevention comes down to protecting the skin from the sun and regularly examining the skin, especially if such growth has already occurred.
- Excision with base under local anesthesia
- Mandatory histology
- Observation for benign results
- Treatment of actinic keratosis lesions
- Sun protection: clothing, hat, sunscreen
- Annual skin examination by a dermatologist after removal
