A rare perioral lesion: cutaneous horn of the lower lip
Received: 22 July 2006 / Accepted: 2 October 2006 / Published online: 10 January 2007
Abstract Cutaneous horns are uncommon lesions consist-
ing of keratotic material; they resemble mini animal horns.
They typically occur in sun-exposed areas, particularly the
face, ear, nose, forearms, and dorsum of the hands. A case
of cutaneous horn of the lower lip is presented as an
extremely rare perioral pathology. The purpose of this paper
is to highlight the need for a careful management of such
lesions due to the high incidence of malignant or
Keywords Cutaneous horn
Split-lip advancement technique (SLAT)
A cutaneous horn (cornu cutaneum) is a prominent, often
conical, hyperkeratotic lesion that resembles an animal horn.
Based on a recent literature review by Bondeson ,
cutaneous horns in humans were initially described by a
London surgeon, Everard Home, in 1791. They are charac-
terized by hyperproliferation and increased cohesiveness of
keratin due to an unknown mechanism . They may be
associated with a broad spectrum of pathology at their base,
this may be benign, premalignant, or malignant [1, 2, 9]. The
lesions typically occur in sun-exposed areas, particularly the
upper face, scalp, ear, nose, neck and shoulder, legs, forearm,
and the dorsum of the hand [1, 3, 6, 8, 9].
This article presents a large cutaneous horn on the
lower lip. This is a very rare location for this pathology;
a literature review revealed only four previous reports
[2, 6, 8, 9].
A 16-year-old-male was referred to our institution because
of a cutaneous horn located at the vermilion of the lower lip
(Fig. 1). The lesion had been present for 3 years. He was
the son of a farmer and worked in the sunlight all day. He
was a nonsmoker but had poor oral hygiene. Examination
revealed a cutaneous horn arising from the lower lip
vermilion near the left oral comissure. The size of the horn
from the base to the tip was 3.2 cm; the diameter was
0.9 cm. There was white plaque surrounding the base of the
horn. There were no enlargements of regional lymph nodes
and he was in good health.
Under infiltration anesthesia with 1% lidocaine in
1:200,000 adrenaline, the lesion was excised with a 1-cm
margin. The excision resulted with a large full-thickness
vermilion defect together with one-third of the lower lip
(Fig. 2). The defect consisted of vermilion, mucosa, and
submucosal layers of the buccal surface of the lower lip.
The reconstruction chosen was the split-lip advancement
technique (SLAT) ; this was originally described for the
treatment of congenital sinuses of the lower lip (Fig. 3).
The lip reconstruction healed uneventfully. The functional
and aesthetic result was good and the scarring was
minimum (Fig. 4). Histology revealed diffuse hyperkerato-
sis and parakeratosis, consistent with a cutaneous horn.
At the base of the lesion, there were typical histological
Eur J Plast Surg (2007) 29:339–341
M. Mutaf (*)
Department of Plastic and Reconstructive Surgery,
Gaziantep Medical Faculty,
Universite PTT Subesi, PK: 6,