Vano-Galvan and Sanchez-Olaso 359 (9): e10, Figure 1 August 28, 2008

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A healthy 84-year-old woman presented with a 6-month history of a slowly growing asymptomatic lesion on the dorsum of her right hand. Physical examination revealed a keratotic cutaneous horn — approximately 6 to 7 cm in length and yellow-gray in color, with a firm consistency — on the dorsoulnar aspect of the base of the right index finger (also involving the web between the index and middle fingers), without associated lymphadenopathy. The lesion was completely excised surgically. Histologic examination showed neoplastic proliferation of atypical keratinocytes extending into the dermis, with large hyperchromatic and pleomorphic nuclei. On the basis of the clinical and histologic findings, a diagnosis of invasive cutaneous squamous-cell carcinoma was made. Imaging and analytical studies revealed neither bony involvement nor metastatic disease. Various types of associated lesions may be found at the base of a cutaneous horn, including squamous-cell carcinoma, other tumors, viral warts, actinic keratosis, keratoacanthoma, Bowen's disease, seborrheic keratosis, and basal-cell carcinoma. The patient underwent two surgical interventions, finally requiring the amputation of the index and middle fingers to achieve tumor-free margins. No clinical relapses were detected after 2 years of follow-up.

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