Cutaneous Horn of the Eyelid in 13 Cases

Introduction: Cutaneous horn of the eyelid is uncommon. The authors evaluate the features of benign, premalignant, and malignant tumors at the base of cutaneous horn of the eyelid. Objective: To describe the clinical and histopathologic features of cutaneous horn of the eyelid. Design: A retrospective analysis of 13 cases of cutaneous horn of the eyelid treated between 1994 and 2014 was performed. Participants: Thirteen patients participated in this study. Main outcome measures: Main outcome measures include clinical and histopathologic features and outcomes of cutaneous horn. Results: The mean patient age was 54 years (median 64 years, range 9–91 years), and 6 patients (46%) were women. The cutaneous horn affected the upper (n = 5), lower (n = 6) eyelid, or was not indicated (n = 2). The mean height of the cutaneous horn was 7.6 mm (median 8mm, range 4-12 mm) and mean basal diameter was 3.8 mm (median 3mm, range 2-6 mm). The cutaneous horn was comprised of superficial layers of keratin with hyperkeratosis and parakeratosis overlying a solid tumor at the base in all cases. The tumor base included benign (n = 6, 46%), premalignant (n = 4, 31%), and malignant (n = 3, 23%) conditions. The benign basal lesions included seborrheic keratosis (n = 1), nevus sebaceous of Jadassohn (n = 1), pseudoepitheliomatous hyperplasia (n = 1), trichilemmoma (n = 1), and inverted follicular keratosis (n = 2). Premalignant basal lesions were actinic keratosis (n = 4), and malignant basal lesions included squamous cell carcinoma (n = 2) and sebaceous gland carcinoma (n = 1). Conclusions: The clinical significance of cutaneous horn of the eyelid lies not in the horn itself but the nature of the underlying base. Malignancy was found in 23% of patients.

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