Hyperkeratotisch papilloom - Huidziekten en Behandelingsopties

Pathophysiology

A cutaneous horn is a well-circumscribed, hyperkeratotic lesion with a height that is more than half of the diameter of its base. It can arise from any part of the skin or mucosa, with its pathophysiology being dependent upon the underlying disease. Lesions associated with benign disease processes tend to grow slowly over a few months to years.[6] However, diseases with a higher mitotic activity rate, such as SCC, can lead to a rapid growth phase and the development of horns. The more significant cumulative actinic damage and higher rates of neoplastic degeneration found in older adults make this population more prone to malignant horns.[7] Lesions with a wider base are more likely to be malignant than those with a narrower base.[6]

Montgomery (1941) classified cutaneous horns into 5 types. These subtypes were distinguished by appearance, histological structure, and causation.[14]

The dermatology community has since moved away from Montgomery’s classic subtypes in favor of a classification system focused on underlying etiology. Although patients may still be described as having a Montgomery Type 5 cutaneous horn,[14] histopathological analysis of the underlying lesion and subsequent determination of the underlying pathology is the current model for cutaneous horn classification, namely, benign, premalignant, or malignant with a distinct variety of underlying causations defined for each category.

Introduction

Seborrheic keratoses (SKs) are the most common benign epithelial tumours of humanity with an increasing incidence with age. The predilection zones of SKs are trunk and forehead. An important clinical sign is the formation of multiple horn pearls [1]. In dermoscopy, comedo-like openings, milia-like cysts, and fissures and ridges are characteristic [2]. Although most SKs have a maximum diameter of less than 4 cm, sometimes giant lesions develop that raises some possible differential diagnoses including Buschke-Löwenstein tumours [3].

On the histologic level six subtypes can be differentiated: - hyperkeratotic type, - acanthotic type, - reticular/adenoid type, - clonal type, - irritated type, - melanoakanthoma [1]. Multiple eruptive SKs was known as Leser-Trélat-syndrome gain importance as a paraneoplasia [4].

Hoe vaak komt actinische keratose voor?

Ongeveer de helft van alle mannen boven 45 jaar en een derde van de vrouwen boven de 45 jaar heeft tenminste één actinische keratose. Dat komt neer op ongeveer 1,4 miljoen Nederlanders. Het komt dus erg vaak voor. Dit komt onder andere door veranderende vrijetijdsbesteding, zonnebanken en zonvakanties. Actinische keratose komt vaker voor bij mensen met een blank huidtype (blond haar en blauwe ogen).

Ongeveer 10% van de patiënten met actinische keratosen ontwikkelt een huidkanker, meestal het plaveiselcelcarcinoom. De kans dat iemand een plaveiselcelcarcinoom krijgt is afhankelijk van de hoeveelheid actinische keratosen. Dit is ongeveer 1% als iemand minder dan vijf actinische keratosen heeft, tot 20% als iemand meer dan twintig actinische keratosen heeft.

Prognosis

The prognosis is dependent upon the classification of the underlying proliferative lesion at the base of the horn (eg, actinic keratosis, squamous cell carcinoma)

The lesion at the base of the keratin mound is benign in the majority of cases. Malignancy is present in up to 20% of cases, with squamous cell carcinoma being the most common type. The incidence of squamous cell carcinoma increases to 33% when the cutaneous horn is present on the penis. [28, 33] Tenderness at the base of the lesion is often a clue to the presence of a possible underlying squamous cell carcinoma. [4] Bleeding at the base of the lesion, as well as larger size, have been suggested as an indication of underlying malignancy. [2, 32]

References

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