International Surgery Journal | April-June 2016 | Vol 3 | Issue 2 Page 988 International Surgery Journal Gupta R et al. Int Surg J. 2016 May;3(2):988-990 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Cutaneous horn developing over a verrucous carcinoma: a rare entity with an unusual presentation Rajesh Gupta*, Prashant Lavania, Vikas Kumar Bansal, Neelabh Agarwal, Aradhana Singh INTRODUCTION The main purpose of this case report is to enhance our knowledge about the occurrence of cutaneous horns and the pathological factors contributing to it. Cutaneous horn occurs in coalition with or as a reaction to a wide variety of underlying benign premalignant and malignant skin diseases. 1 The earliest well-documented case of cornu cutaneum from London in 1588 is of Mrs. Margaret Gryffith, an elderly Welsh woman. However, earliest observations on cutaneous horns in humans were described by the Everard Home in 1791. 2 Farris from Italy first described the gigantic horn in man as a well documented a case report with adequate histology. 3 Cutaneous horn or cornu cutaneum is a keratotic mass arising from the cutis. 4 Cutaneous horns most frequently occur in sites that are exposed to actinic radiation or burns, and hence, are commonly found on exposed parts like upper parts of the face, eyelid, neck, scalp, nose but as shown in this case report, these may occur in other non-exposed sites also. The color of these horns can vary from white to yellow to black depending on the amount of keratin deposition. Cutaneous horns may be straight or curved and twisted, and vary from a few millimeters to several centimeters in length. Over 60% of the lesions are benign, however, malignant or premalignant lesions might be associated with it. 5 Keratosis, Bowen’s disease, trichilemma, sebaceous molluscum, verruca, basal cell carcinoma, epidermoid carcinoma and malignant melanoma have all been described in association with cutaneous horns. 6 Because of their malignant potential, the lesions must always be considered for histopathological evaluation. Here we report a patient of cutaneous horn on top of verrucous carcinoma. CASE REPORT A 65-year-old female presented with a bony horn like painless growth over the lateral aspect of right thigh of more than 5 months duration (Figure 1). Initially patient noticed small cystic swelling over the lateral aspect of right thigh 50 years back. She did not take any treatment for the swelling as it was painless and was not interfering with her day to day activities. Three years back she developed pain and pus discharge from swelling. Swelling was excised by an unqualified doctor. She slowly developed this cutaneous horn over the swelling since 5 months. Local examination revealed a hard curved growth on the lateral aspect of right thigh, measuring about 8 cm in length and about 5 cm wide at ABSTRACT Cutaneous horn (cornu cutaneum) is a very rare lesion resembling the horn of an animal. It consists of a projectile, conical, dense, hyperkeratotic nodule. The horn is frequently conical, made of stratum corneum. Diagnosis is easily made clinically and can be confirmed by histopathology. We report a case of 65 year old female, who had a cutaneous horn for over 5 months, which turned out to be growing over a verrucous carcinoma. Keywords: Cornu cutaneum, Verrucous, Cutaneous horn, Malignant Department of General Surgery, S N Medical College, B R Ambedkar University, Agra, UP, India Received: 08 February 2016 Accepted: 08 March 2016 *Correspondence: Dr. Rajesh Gupta, E-mail: rkg04@rediffmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20161185