Cutaneous Horn of the Eyelid in 13 Cases

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.

To describe the clinical and histopathologic features of cutaneous horn of the eyelid.

A retrospective analysis of 13 cases of cutaneous horn of the eyelid treated between 1994 and 2014 was performed.

Thirteen patients participated in this study.

Main outcome measures include clinical and histopathologic features and outcomes of cutaneous horn.

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).

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.