Nasal septal verrucous carcinoma presenting as a cutaneous horn

Abstract

Background: Cutaneous horn arising from the nasal vestibule is an extremely rare entity with only four published case reports to date. Although cutaneous horns are commonly benign, the risk of it harboring a malignant or pre-malignant process is about one in three. Verrucous carcinoma is a variant of squamous cell carcinoma (SCC) that typically presents in the oral cavity, and very rarely in the nasal cavity. Case Presentation: We report a 78-year-old female who presented with a rapidly enlarging right naris cutaneous horn of 5 months duration. Computed tomography scan showed a heterogeneously enhancing mass at the right anterior nasal cavity with no overt bone or cartilage destruction. Differential diagnoses included seborrheic keratosis, actinic keratosis, viral wart, and malignant tumors such as SCC. She underwent an excision biopsy and histology confirmed the diagnosis of a pT1 verrucous SCC. Conclusion: Due to the rarity of the site of the disease, management of sinonasal verrucous carcinoma is generally derived from management options of other subsites in the head and neck region. The preferred treatment modality is surgical excision, while primary radiotherapy is an emerging treatment alternative in poor surgical candidates.