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Latest update 16/06/09
Definition and aetiology
- A cutaneous horn (CH) is not a diagnosis but a clinical presentation
- Although a CH can represent a viral wart or actinic keratosis (AK), 15% will reflect underlying squamous cell carcinoma (SCC)
Management
- If an SCC is suspected the patient should be referred under the two-week rule to secondary care
- Lesions with a more benign appearance should be treated either by curettage or excision and sent for histology to rule out SCC. If curettage is used a deep enough sample must be obtained in order to get an accurate histological diagnosis
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Figure 1 – Cutaneous Horn
The horn sits on relatively healthy looking skin. On palpation no induration was noted
From a clinical perspective it was felt unlikely that the lesion was an SCC and to this end the horn was treated by curettage and sent for histology. The result showed a a viral wart
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Figure 2 – CH resulting from an SCC
The indurated firm base (black arrow) increased the level of clinical suspicion. The lesion was excised and histology confirmed an SCC
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Figure 3 – A CH sitting on an obvious SCC
The patient was referred to the plastic surgeons without a biopsy
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