LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 2 | Page : 177-178
Cutaneous horn on the penile shaft
Ramesh Kumar Kushwaha, Alpana Mohta, Umesh Gautam, Suresh Kumar Jain
Department of Dermatology, Venereology and Leprosy, GMC, Kota, Rajasthan, India
|Date of Submission||30-Sep-2019|
|Date of Decision||04-Dec-2019|
|Date of Acceptance||15-Feb-2021|
|Date of Web Publication||27-Jul-2021|
Dr. Suresh Kumar Jain
Department of Dermatology, Venereology and Leprosy, GMC, Kota - 324 005, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kushwaha RK, Mohta A, Gautam U, Jain SK. Cutaneous horn on the penile shaft. Indian J Sex Transm Dis 2021;42:177-8
Cutaneous horns are uncommon lesions consisting of tenacious keratinized material, arising from a wide range of lesions. They occur most frequently over exposed sites such as upper part of face, scalp, nose, neck, and chest. However, a horn over the penis is a rarely reported entity.
A 60-year-old man presented with gradually progressive, asymptomatic outgrowth on the dorsal aspect of the penis since the last 5 months. It started as small papular lesions on shaft of penis 2 years back. He had another similar papular lesion on the scrotum appearing around the same time. The lesion on the shaft changed into elongated, hard horn-like projection while scrotal lesion subsided on its own. Systemic examination did not reveal any abnormality. Dermatological examination revealed single, hard, cutaneous horn on the middle of the shaft of the penis [Figure 1]. The horn was around 1 cm in diameter and 1.5 cm in length, slightly curved, yellowish-brown in color. A surrounding collarette of skin was observed. There were no similar lesions over other body parts.
|Figure 1: Horny outgrowth on the dorsum of penile shaft with a peripheral collarette of skin|
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A clinical diagnosis of cutaneous horn was made. However, a punch biopsy was performed to ascertain the primary lesion giving rise to the horn. Hematoxylin and eosin stain revealed acanthosis, papillomatosis, and hyperkeratosis with arborization. Vertical tiers of parakeratotic cells with koilocytes and foci of clumped keratohyalin granules were seen [Figure 2]. The histopathological features were consistent with verruca vulgaris underneath cutaneous horn. The patient was assured about the benign nature of the condition. Total resection was done under local anesthesia and the resected specimen was sent for histopathological examination.
|Figure 2: Koilocytes (vacuolated cells with pyknotic nucleus) underlying arborizing parakeratotic columns (H and E, ×240)|
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Cutaneous horn (synonyms; Cornu cutaneum: Cornu humanum), documented for the first time in 1588, is a conical, hyperkeratotic protrusion that often resembles an animal horn. It is a morphological term which refers to a firmly term cohesive keratinized material instead of being a true pathologic diagnosis. All variants of horns, including penile horns, are encountered most often in people above 50 years of age. According to a report by Lowe and McCullough reported that in up to 42%–56% cases penile horn are benign, whereas rest of the cases are premalignant or malignant. The common causes of benign penile horn include verruca vulgaris, condyloma accuminata, molluscum contagiosum, keratoacanthoma, etc., whereas, those of premalignant and malignant horns include arsenical keratosis, verrucous carcinoma, squamous cell carcinoma, pseudoepitheliomatous micaceous balanitis, and squamous cell carcinoma, to name a few. The cause of the horn can be identified on histopathological examination. It is divided into two parts. First, the features common with all cutaneous horns are, the overlying keratotic mass consisting exclusively of keratin along with closely packed agglutinated epidermis cells arranged in concentric columns and hypertrophic papilla. Second, the pathological features underlying the keratotic mass which reveal the cause of the horn. These features may vary anywhere from verruca vulgaris to squamous cell carcinoma.
It is important to rule out an underlying malignancy indicated by induration and inflammation at base. Electrosurgical excision, laser and cryosurgery are curative in benign cases. However, malignant dermatoses require regular follow-up for recurrence. It is pertinent for both dermatologists and surgeons to be aware of the possibility of underlying malignancy so as not to treat all cases as innocuous and benign.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Bondeson J. Everard Home, John Hunter, and cutaneous horns: A historical review. Am J Dermatopathol 2001;23:362-9.
Karthikeyan , Thappa DM, Jaisankar TJ, Balamourougane , Ananthakrishnan N, Ratnakar C. Cutaneous horn of glans penis. Sex Transm Infect 1998;74:456-7.
Lowe FC, McCullough AR. Cutaneous horns of the penis: An approach to management. Case report and review of the literature. J Am Acad Dermatol 1985;13:369-73.
Karthikeyan K. Penile cutaneous horn: An enigma-newer insights and perspectives. Indian J Sex Transm Dis AIDS 2015;36:26-9.
Schellhammer PF, Jordan GH, Robey EL, Spaulding JT. Premalignant lesions and nonsquamous malignancy of the penis and carcinoma of the scrotum. Urol Clin North Am 1992;19:131-42.
[Figure 1], [Figure 2]