Letter to the Editor : Cutaneous Horn Arising from Keratoacanthoma = Letter to the Editor : Cutaneous Horn Arising from Keratoacanthoma

다국어 초록 (Multilingual Abstract)

Cutaneous horn is an epidermal tumor, which appears as a protruding conical mass of keratin. The height of the keratotic mass should amount to at least half of its diameter to be defined as cutaneous horn1. The lesion can be derived from various underlying lesions, which may be benign, premalignant, or malignant. Therefore, it is important to accurately determine the base of the lesion by histopathologic confirmation2. We report a case of cutaneous horn on the anterior chest of a healthy 66-year-old man. A 1.1×1.2× 1.2 cm-sized, white-grayish hyperkeratotic horn-like tumor was observed for 6 months (Fig. 1A, B). It had been slowly growing without pain or pruritus. Additionally, the patient had no history of trauma or contact with irritants. The lesion was removed by surgical excision (Fig. 1C). Histopathologic study showed marked hyperkeratosis of the cutaneous horn and irregular epidermal proliferation, acanthosis, and a crater-shaped, keratin-filled structure, all of which are characteristic findings of keratoacanthoma (Fig. 2). Keratoacanthoma is a common but unique neoplasm, usually demonstrating rapid growth. Histopathologic patterns show marked hyperkeratosis and irregular epidermal proliferation, acanthosis, and crater-shaped, keratin-filled structures. Keratoacanthoma has unique clinical stages including proliferating, mature, and resolving. The process from origin to spontaneous resolution usually occurs within 4∼6 months. However, rapidly growing lesions can cause widespread tissue destruction. Additionally, it is sometimes difficult to differentiate keratoacanthoma from squamous cell carcinoma in very early lesions. Therefore, complete surgical excision is recommended3. Its clinical manifestation and the presence of a large crater filled with keratin were consistent with keratoacanthoma. A cutaneous horn is an epidermal tumor composed of compact keratin projecting above the surface of the skin. It differs from animal horn by the absence of a central bone1. Because the lesion can be derived from many primary underlying lesions, it is important to investigate the derivation of the lesion in order to guide further treatment and establish prognosis1,2. The patient is currently being monitored for recurrence and a regular check-up is recommended. Though cutaneous horn arising from keratoacanthoma is not actually rare, the frequency of these cases is underestimated. In the literature, descriptions of cutaneous horn originating from keratoacanthoma are sparse and only 2 such cases were previously reported in Korea (Table 1)4,5. We report a case of a cutaneous horn arising from keratoacanthoma in a 66-year-old male patient.

참고문헌 (Reference)

• 1 Schwartz RA, "Keratoacanthoma: a clinico-pathologic enigma" Dermatol Surg 30 : 326 ~ 333, 2004
• 2 Bondeson J., "Everard Home, John Hunter, and cutaneous horns: a historical review" Am J Dermatopathol 23 : 362 ~ 369, 2001
• 3 Fernandes NF, "Cutaneous horn: a potentially malignant entity" Acta Dermatovenerol Alp Panonica Adriat 18 : 189 ~ 193, 2009
• 4 Hwang JY, "Cutaneous horn arising from keratoacanthoma" Korean J Dermatol 36 : 959 ~ 961, 1998
• 5 Jung Hoon Yang, "A Case of Cutaneous Horn Originating from Keratoacanthoma" Annals of Dermatology 23 (1) : 89 ~ 91, 2011