Cutaneous Horn Revisited: A Woman With a Verruca Vulgaris-Associated Cornu Cutaneum

Alexander R Kheshvadjian,Philip R Cohen,Christof Erickson,Antoanella Calame

doi:10.7759/cureus.19925

Abstract

A cutaneous horn, sometimes referred to as cornu cutaneum, is a projection arising on the skin due to an overgrowth of the epidermal stratum corneum. This lesion is a clinical presentation of an underlying skin tumor. A woman with a verruca vulgaris-associated cutaneous horn is described. Cutaneous horns are often solitary and appear most commonly on the face, ears, and the dorsum of the hands of older patients. The most frequent tumors associated with cutaneous horns include actinic keratoses and seborrheic keratoses; however, cutaneous horns have also been observed overlying other benign and malignant tumors. In conclusion, a cutaneous horn is a common clinical feature; however, the diagnosis of the underlying skin lesion requires a biopsy that permits adequate microscopic evaluation of the associated tumor.

Highlights

Cutaneous horns are described as exophytic keratotic mounds overlying the epidermis
If the cutaneous horn is not associated with verruca vulgaris, the appropriate management should be dictated by the diagnosis of the lesion beneath the horn [1,2,4,5,6]
We described a woman with a verruca vulgaris-related cutaneous horn

Summary

Introduction

Cutaneous horns are described as exophytic keratotic mounds overlying the epidermis. In order for the lesion to be termed as a “horn,” the height of the lesion must be greater than at least one-half of its greatest diameter. An 81-year-old woman presented for evaluation of an enlarging lesion on her left forearm of two-years duration. She had applied garlic to the lesion; there was no improvement. Distant (A) and closer (B) views of a verruca vulgaris (red arrow) associated with overlying cutaneous horn (black arrow) on the left forearm of an 81-year-old woman. In the thickened stratum granulosum (red circle) (A, C, and D), there are halo cells (red arrows showing koilocytes) (D) indicative of human papillomavirus infection; these are the pathologic features of a cup-shaped verruca vulgaris. Correlation of the pathologic findings and clinical presentation established the diagnosis of cup-shaped verruca vulgaris associated with an overlying cutaneous horn.

Discussion

Conclusions

Disclosures

Mehregan AH