British Man Grows 'Dragon Horn' On His Back In Rare Case

The cutaneous horn developed by the patient. Plnczak et al./BMJ Case Reports 2019

A recent BMJ Case Report details the peculiar shape of a type of skin cancer that was left untreated for over three years and developed into a growth that reminded doctors of a dragon horn.

The condition is known as cutaneous squamous cell carcinoma (cSCC), the second most common non-melanoma skin cancer. The patient was a 50-year-old manual laborer. He did not have many of the risk factors typically associated with skin cancer. No significant sun exposure, no family history of skin cancer, and he was not immunosuppressed. The report notes that he was a smoker.

The cancer was located on the man’s lower back. It reached a length of 14 centimeters (5.5 inches) and was about 6 centimeters (2.4 inches) thick. Cutaneous horns such as this can be the result of benign, pre-malignant, or malignant tumors, but squamous cell carcinoma has been reported in 94 percent of horns with a malignant base.

Plnczak et al./BMJ Case Reports 2019

The recommended treatment for such cancer is surgical removal. The horn was extracted by surgeons while the patient was under general anesthesia. They had to remove a fair chunk of healthy skin too, stretching about 8 millimeters around the horn and 7 millimeters deep into the skin. A skin graft, from the patient’s own thigh, was applied to reconstruct the area.

Most cases of cutaneous squamous cell carcinoma are diagnosed and treated early so they don't have the chance to become ‘dragon horns’. This should have been the case in this scenario given that the patient lives in the UK, where there’s free healthcare. For the medical practitioners this suggests that “despite current public skin cancer awareness and rigorous healthcare measures, SCCs as big as this can still arise and slip through the net.”

The condition makes up 20 percent of all skin cancer cases with about one in eight US men developing cutaneous squamous cell carcinoma during their life. Risk factors include light skin, total ultraviolet radiation exposure, chronic wounds, arsenic exposure, HPV infections, and poor immune system function. The prognosis is usually good and despite 2.2 million people being diagnosed with the disease in 2015, only 51,900 died as a result.

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