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Invasive SCC with cutaneous horns present in older patients

Patients with invasive squamous cell carcinoma and horn presentation tended to be older than patients with the skin cancer without horns, and the presence of horns was associated with reduced tumor diameter and depth compared with nonhorns, according to published study results.

Researchers in Australia studied 842 patients (63.5% males), with 1,666 invasive squamous cell carcinoma (SCC) cases, including 116 presenting as horns.

Patients presenting with horns were significantly older, with a mean age of 78 years at first SCC, compared with 73 years in patients without horns (P = .008). Most patients with horns were diagnosed between ages 75 and 84 years. Sex and grade of differentiation between horn and nonhorn SCC cases showed no significant differences.

The most frequent anatomic sites for SCC cases with horns were hands (15%), forearms (13%), legs (13%), backs (8%) and ears (8%), while the most frequent anatomic sites for SCC cases without horns were legs (17%), forearms (11%), hands (11%), forehead (10%) and the cheek or chin (9%).

Median tumor diameter significantly lower for SCC cases with horns: 6 mm for the SCC cases vs. 8 mm for the SCC cases without horns. The median depth of SCC without horns was 1.3 mm, which was significantly deeper than the cases with horns (0.8 mm).

“Horn cases had a borderline significant shift to well differentiation with moderate differentiation in 11.2% of cases (n = 13) and poor differentiation in 0.9% (n =1),” the researchers wrote.

After adjustment using multivariate logistic regression models assessing the covariates of age, sex, anatomic site, diameter, depth and grade of differentiation, the patients with SCC without horns were found to be younger than patients with horns (OR = 0.96; 95% CI, 0.94-0.98), and the patients without horns were likely to have a tumor that was larger in diameter (OR = 1.25; 95% CI, 1.15-1.35) and deeper (OR = 1.36; 95% CI, 1-1.85).

“This study found invasive SCC presenting with cutaneous horns tends to present in older patients,” the researchers concluded. “Horns may also have a shallower depth of invasion and a smaller diameter compared with invasive SCC not presenting with horns.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.