Cutaneous horn occurring on the oral tissues: report of a case and review of literature

Fallieri, Lucas C.; Ferreira, Gabriela T.; Barbosa, Beatriz M. C.; Araújo, Marcelo S.; Henrique, Paulo Roberto; Servato, João Paulo S.

doi:10.5935/1676-2444.20210032

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Jornal Brasileiro de Patologia e Medicina Laboratorial

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CASE REPORT • J. Bras. Patol. Med. Lab. 57 • 2021 • https://doi.org/10.5935/1676-2444.20210032 copy

Cutaneous horn occurring on the oral tissues: report of a case and review of literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The aim is to describe the clinical-pathological and treatment data of a patient with a cutaneous horn (CH) arising on oral tissues and to compare this with a literature-review. This case affects the lower-lip of an 86-years-old female. After excisional biopsy, the histopathological examination revealed a CH associated with actinic cheilitis. Only 23 similar cases have been reported in literature. At this site CH mainly affects the lower-lip of white males in a wide-age range. Excision should be the treatment of choice to enable pathological examination of the underlying lesion, since most cases were associated with pre-malignant/malignant lesions.

Key words:
cheilitis; mouth; lip; epidemiology

Number	Gender/age (years)	Skin color	Site	Size (cm)	Underlying pathology	Treatment	Recidive?	Outcome/follow-up (months)
1 [6]	M/56	W	LL	-	Acanthosis and epithelial dysplasia	ST	No	NED/-
2 [7]	M/50	-	LL	-	-	ST	No	NED/-
3 [8]	M/21	NW	LL	1.2 × 0.8	Acanthosis and epithelial dysplasia	ST/isotretinoin	Yes – 3×	AWD/-
4 [9]	M/11	NW	LL	2.4 × 0.8	Pyogenic granuloma	ST	No	NED/19
5 [10]	F/45	-	BM	2 × 0.8	Basal cell carcinoma	ST	No	NED/-
6 [10]	F/67	W	LL	2.5 × 0.6	Actinic keratosis	ST	No	NED/-
7 [11]	F/50	NW	LL	1 × 0.5	Pyogenic granuloma	ST	No	NED/12
8 [12]	M/16	W	LL	3.2 × 0.9	Acanthosis and epithelial dysplasia	ST	No	NED/36
9 [13]	F/72	W	UL	2 × 0.8	Well-differentiated SCC	ST	No	NED/66
10 [14]	M/72	W	LL	3.2 × 2.5	Well-differentiated SCC	ST	No	NED/24
11 [15]	M/45	W	LL	3 × 1.5	Keratoacanthoma/well-differentiated SCC	ST	No	NED/24
12 [16]	M/9	NW	UL	-	Discoid lupus erythematous	ST	No	NED/-
13 [17]	M/45	NW	OC	3 × 1	Verrucous carcinoma	ST	No	NED/24
14 [18]	F/76	W	LL	6.3 × 1.9	Well-differentiated SCC	ST	No	NED/37
15 [19]	M/66	W	UL	3 × 2	Well-differentiated SCC	ST	No	NED/24
16 [20]	M/77	W	LL	3 × 2	Keratoacantoma	ST	No	NED/24
17 [21]	M/74	-	LL	0.6	Actinic keratosis	ST	No	NED/12
18 [22]	F/63	NW	OC	3 × 1	Well-differentiated SCC	ST	No	-/-
19 [23]	F/82	W	UL	3.5	Well-differentiated SCC	ST	No	NED/6
20 [24]	M/11	NW	LL	2 × 1	Pyogenic granuloma	ST	No	NED/2
21 [25]	M/59	NW	UL	1.5	Verrucous carcinoma	ST	Yes – 2×	-/-
22 [26]	F/52	NW	OC	3 × 1	Verrucous carcinoma	ST	No	NED/-
23^* * current study.	F/86	W	LL	1.5 × 1	Acanthosis and epithelial dysplasia	ST	No	NED/24

Gender	M:F ratio: 1.6:1
Age (years)	Mean: 52.4 ± 24.1 (range: 9-86)
Skin color	W:NW ratio: 1.2:1
Site	Lower lip: 14/23 (60.9%)
	Upper lip: 5/23 (21.7%)
	Oral commissure: 3/23 (13.1%)
	Buccal mucosa: 1/23 (4.3%)
Size (cm)	Mean: 2.5 ± 1.2 (range: 0.6-6.3)
Signs and symptoms	Swelling: 23/23 (100%)
	Itching and/or soreness: 2/23 (8.7%)
	Bleeding: 1/23 (4.3%)
Evolution time (months)	Mean: 22.2 ± 17 (range: 1-60)
Underlying pathology	Benign: 4/22 (18.2%)
	Pre-malignant: 7/22 (31.8%)
	Malignant: 11/22 (50%)
Treatment modalities	ST: 22/23 (95.7%)
Treatment modalities	ST + isotretinoin: 1/23 (4.3%)
Recidive?	Yes: 2/23 (8.7%)
Outcomes	NED: 20/21 (95.2%)
Outcomes	AWD: 1/21 (4.8%)
Follow-up (months)	Mean: 23.9 ± 15.7 (range: 2-66)

Data	Sub-groups	Benign/pre-malignant	Malignant	p^ * OneFisher's exact test (one-sided);*
Gender	Male	8	5	NS
Gender	Female	3	6	NS
Age	≥ 45 years	6	11	0.0175
Age	< 45 years	5	0	0.0175
Skin color	White	5	6	NS
Skin color	Non-white	5	4	NS
Site	Lower lip	10	3	0.0038
Site	Others	1	8	0.0038
Size	≥ 3 cm	2	8	0.0349
Size	< 3 cm	7	3	0.0349
Signs and symptoms	Only swelling	7	10	NS
Signs and symptoms	Swelling + others	3	0	NS
Evolution time^ segregated accordingly with median.	> 21 months	4	4	NS
Evolution time^ segregated accordingly with median.	≤ 21 months	3	4	NS
Recidive?	Yes	1	1	NS
Recidive?	No	10	10	NS

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[1] CORRESPONDING AUTHOR João Paulo Silva Servato e-mail: jpservato@gmail.com