A Malaysian woman developed ‘ram’s horns’ on one of her breasts after an ‘extremely rare’ case of viral warts.
The 63-year-old, who wasn’t identified, told doctors the growths had spontaneously appeared on the left side of her chest two years ago.
By the time she went to hospital they had grown to around 5cm (2inch) in length and had become itchy.
The woman was told she had cutaneous horns (CH), which occur due to a build-up of keratin, a protein in hair, skin and nails.
Doctors believe the horns formed as the result of a skin infection after tests ruled out cancer. But exactly how is ‘still a mystery’.
Doctors at the Hospital Queen Elizabeth 2 in Kota Kinabalu surgically removed the horns and the patient made a full recovery.
The tale was revealed in a case report published in the journal the Annals of Medicine and Surgery.
A Malaysian woman developed ‘ram’s horns’ on her left breast after a rare case of viral warts
Writing in the report, the medics said: ‘Cutaneous horns usually appear as elongated projections ranging from a couple of millimetres to centimetres.
‘It could also be described as a ram’s horn. It gradually grows over the years.’
The Malaysian woman went to hospital complaining of the horn-like growths that caused her ‘on and off itchiness’.
Scans revealed the masses had formed on the surface of the skin and had not spread to the breast tissue itself.
There were no signs of inflammation or soreness, which gave the medics confidence it was not cancerous.
Doctors performed a bedside excision to remove the horns and sent off samples to be tested for the disease — which came back negative.
The patient did not have warts on any other part of her body and was not suffering from other skin conditions.
Writing in her case report, published on April 8, the medics said: ‘As of this writing she is in good health and shows no signs of recurrence.’
‘Her scar from the biopsy is well healed and does not show any signs of recurrence after follow up for six months.’
The prevalence of cutaneous horns is not known but the medics described them as ‘extremely rare’.
Causes are not clear but scientists have previously found links to radiation and UV exposure.
Research suggests the most common cause is actinic keratosis, which occurs due to overexposure to UV radiation.
But the most recent case was judged to have been caused by verrucae vulgaris, viral warts caused by human papillomaviruses (HPV).
The normally harmless viruses can enter the skin and cause a skin infection that forms warts.
The most common location for cutaneous horns are the scalp and upper face, or other areas most exposed to the sun such as the chest, shoulder and neck.
However, they have been found all over the body, including on the penis.
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