Cutaneous horn

Author: Dr Tina Tian, Medical Oncology Registrar, Hawke's Bay Hospital, Hastings, New Zealand, 2013.

What are cutaneous horns?

Cutaneous horns (cornu cutaneum) are hard conical projections from the skin, made of compact keratin. They are so named as they resemble an animal’s horn. They arise from benign, premalignant or malignant skin lesions.

More images of cutaneous horns ...

Who gets them?

What causes cutaneous horns?

Around half of horns have a benign base, and half are premalignant or malignant. The most common lesions are seborrhoeic keratosis (degenerative), viral warts (due to human papillomavirus), solar (actinic) keratosis and well-differentiated squamous cell carcinoma (associated with exposure to the sun and other sources of UV radiation).

Clinical features of cutaneous horns





Cutaneous horns are usually asymptomatic, however as they are protuberant, they can be injured causing pain and inflammation.

Worrying features suggestive of malignancy

Whilst no certain features can confidently confirm or exclude malignant lesions, malignant lesions are more common in older patients and in males compared to females. Squamous cell carcinoma is also likely if the horn has the following features:

Diagnosis and investigation of cutaneous horn

On histology, there is thickening of the stratum corneum (the top layer of the skin) or hyperkeratosis. Orderly horizontal parallel layers of keratin are associated more with benign lesions. Rapidly growing malignant lesions exhibit a more erratic growth. Acanthosis (thickening of the epidermis) is often noted. The base of the lesion shows features of the underlying lesion.

Skin conditions associated with cutaneous horns
BenignPremalignant or malignant

Treatment of cutaneous horn

Cutaneous horns are usually excised with appropriate margins, dependent of the nature of the lesion.

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