A labourer who ignored a crusty patch on his skin for three years until it grew into a five-inch ‘dragon horn’ sticking out of his back has finally had it removed after it turned out to be cancerous.
The 50-year-old British patient, who is unidentified, only sought treatment for the so-called ‘cutaneous horn’ when it measured 5.5inches (14cm) in length and 2.3inches (5.8cm) in width.
Tests diagnosed him with a squamous cell carcinoma (SCC), a slow-growing and curable cancer. Most cases are diagnosed and treated early before becoming ‘dragon horns’, according to Cancer Research UK.
But medics at the Countess of Chester Hospital who removed the mass were stunned to discover the disease hadn’t spread to other parts of his body, considering the fact he had never received treatment.
The unusual case was revealed by doctors in the British Medical Journal Case Reports. Doctors say it serves as a reminder that such patients can ‘slip through the net’ even in countries with access to free medical care.
SCCs usually begin on areas exposed to the sun – but the man said he was not a sun-worshipper and had no family history of skin cancer.
The horn was removed from the patient’s back and the gaping hole left behind was reconstructed with a skin graft from his thigh.
A man grew a five-inch horn from his back (pictured) which turned out be cancerous
The ‘dragon horn’ was removed from the patient’s back and the gaping hole below was reconstructed with a skin graft from his thigh, doctors in Chester revealed
Writing in the British Medical Journal Case Reports, the team of doctors at Countess of Chester Hospital described the growth as a ‘dragon horn’.
They wrote: ‘We report a rare case of an extremely large well-differentiated SCC that was neglected by a patient living in a developed country with access to free healthcare.
‘This highlights that despite current public skin cancer awareness and rigorous healthcare measures, cases like this can still arise and slip through the net.’
The man had a three-year history of a growing lump on his back, wrote Dr Agata Marta Plonczak and colleagues.
By the time he saw a doctor, the horn was measured at 5.5inches (14cm) in length and 2.3inches (5.8cm) in width.
A test confirmed a squamous cell carcinoma at the base of the horn, which caused the horn to grow.
SCCs can vary in their appearance, but most appear as a scaly or crusty raised area of skin which may be red and inflamed.
They can be sore or tender and they can bleed but this is not always the case. Most cases are diagnosed and treated early before becoming ‘dragon horns’.
SCC can occur on any part of the body, but they are more common on sun exposed sites such as the head, ears, neck and back of the hands.
A SCC is a type of non-melanoma skin cancer (NMSC) caused by changes in the DNA cells, such as a burn. They rarely spread and are curable, according to Cancer Research UK.
It is the second most common skin cancer in the UK, after melanoma, accounting for 23 per cent of all 100,000 NMSC cases diagnosed each year.
An estimated three million Americans are affected by NMSC a year, which includes basal cell carcinoma and squamous cell carcinoma.
It is not clear why skin cancer can turn into a horn, or how often it happens. Around 20 per cent of horns have a cancerous base.
The horn is hard and yellowish-brown in colour, and mainly appear on the face or ears.
They do not normally grow to a giant size before a patient seeks medical attention.
WHAT IS A CUTANEOUS HORN?
Cutaneous horns (CH) occur due to a build-up of keratin, the same protein that forms hair, skin and nails.
CHs’ prevalence is unknown, however, they are more common in older adults, with 60-to-70 year olds being most affected.
The growths – which can be cancerous – also tend to occur in people with fairer skin, dermatologists say.
The cause of CHs is currently unknown, but scientists have previously found links to radiation and UV exposure.
Around half of CHs have a benign base, with the remainder being malignant or pre-malignant, according to DermNet New Zealand.
The underlying lesion is often seborrheic keratosis, which is one of the most common non-cancerous skin growths in older people.
Other causes can include viral warts, squamous cell carcinoma or the scaly growth actinic keratosis, which occurs due to overexposure to UV radiation.
CHs can be straight or curved and tend to be hard and yellow-brown in colour. They can be surrounded by normal or thickened skin.
The side of the horn can be ridged, while the base may be flat or protruding.
Treatment focuses on removing the CH. The surrounding skin may also be excised depending on the nature of the lesion.
Source: DermNet NZ