Case description

A 43-year-old, Caucasian woman was evaluated for the presence of a mass above the surface of the cutis of the mammary gland.

Clinical findings: Clinical, radiographic and echo-graphic findings were indicative of a collection of firm, thick material. A biopsy was performed, and histopathology demonstrated a conical projection of keratin. Such findings were consistent with a tegument horn.

Outcome: The woman was hospitalized and excision of the mass was performed in the following days. Safety margins were considered to be major than 5 cm in each direction. The mass to date has not recurred.

Conclusions: The woman during a recent journey to Vietnam was being treated for hyperthermia of unknown causes. The drugs consisted in a mixture of herbs and rhinoceros' horn given twice a day in unknown dosages, during a twelve days period. The authors suspect a relationship between the skin horn neoplasm and the use of uncontrolled, potentially noxious drugs such as keratin compacted rhino horn.

Various histological lesions have been documented at the base of the keratin mound, and histological confirmation is often necessary to rule out malignant changes. No clinical features reliably distinguish between benign and malignant lesions. Tenderness at the base and lesions of larger size favour malignancy.

(a) Photograph obtained during the physical examination shows a thick growth protruding from the nipple.

(b) Cranium-caudal mammogram shows dense keratin, which resembles calcification.

Dermal Horn

A cutis horn is a conical projection of keratin above the surface of the skin, in a configuration that resembles a miniature horn. The condition is usually asymptomatic; however, the lesion may grow rapidly and is vulnerable to trauma. Malignant lesions, usually squamous cell carcinomas, may be found at the base of the horn. Other tumours, more rarely found in that location, include Paget disease of the breast, sebaceous adenoma, and granular cell tumour.