Cutaneous Horn (Cornu Cutaneum): Clinical Image, Diagnosis, Differential Diagnosis and Management

 


Title 

Cutaneous Horn (Cornu Cutaneum): Clinical Image, Diagnosis, Differential Diagnosis and Management

Author

Dr. Partha Pratim Mandal
MS (General Surgery)
Associate Professor of Surgery
Consultant Surgeon
West Bengal, India

Introduction

A cutaneous horn (Cornu cutaneum) is a conical, hyperkeratotic projection arising from the skin, composed of compact keratin.
Though it appears dramatic, the real pathology lies at the base, which may be benign, premalignant, or malignant.

This post highlights a clinically encountered case, its diagnosis, importance, and management.

Clinical Presentation

  • Hard, horn-like keratotic projection
  • Yellowish to brown in color
  • Usually painless
  • Commonly seen on sun-exposed areas:
    • Face
    • Scalp
    • Forearm
    • Dorsum of hand

Images above show a classic pedunculated cutaneous horn arising from the Rt Leg.

Provisional Diagnosis

Cutaneous Horn (Cornu cutaneum)

Why Is It Important?

The horn itself is dead keratin, but the base may harbor serious disease.

Underlying pathology at the base may be:

  • Benign
    • Verruca vulgaris
    • Seborrheic keratosis
  • Premalignant
    • Actinic keratosis
  • Malignant
    • Squamous cell carcinoma (most important)
    • Basal cell carcinoma (rare)

Any cutaneous horn must be treated as malignant until proven otherwise.

Differential Diagnosis

Condition Key Feature
Verruca vulgaris Papillomatous base
Actinic keratosis Sun-exposed, erythematous base
Squamous cell carcinoma Indurated, ulcerated base
Seborrheic keratosis Greasy, stuck-on appearance

Management (Standard of Care)

✔ Wide local excision including the base
✔ Histopathological examination mandatory
✔ Further treatment based on HPE:

  • Benign → No further treatment
  • Malignant → Oncological management as per stage

Simple shaving or breaking the horn is incorrect.

Teaching Point (For Exams & Practice)

Cutaneous horn is not a diagnosis — the diagnosis is the lesion at the base.

Copyright / Disclaimer

Images and clinical details are shared for educational purposes only.
Patient identity is protected.


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