A 60-year-old female presented to our hospital with swelling and horn like projection over the dorsum of left foot for the last eight months (Figure 1). On examination, it was a painless, firm, irregular horn like projection on the middle of the dorsum of the foot measuring 2 cm at the base and 4 cm in length, tapering bluntly towards its summit. No similar cutaneous horn elsewhere in the body with no inguinal lymphadenopathy. Mass was excised with macroscopic free margins and histopathological features of hyperkeratotic, parakeratotic epithelium with epithelial pearls was suggestive of cutaneous horn.

The cutaneous horn resembles an animal horn grossly, but it lacks a bony core. It is usually present over the face, ear, nose, forearms and dorsum of hand [1]. The dorsum of foot is an uncommon site for cutaneous horn. Cutaneous horn may form due to repeated friction of a limb of inverted 'V' shaped rubber strap on slipper used by low socio-economic population. Its importance arises from the fact that this lesion can harbour squamous cell carcinoma, when associated with a wide base, but may be associated with other conditions as keratosis, sebaceous molluscum, verruca, trichilemma, Bowen's disease, malignant melanoma and basal cell carcinoma [2]. Majority of cutaneous horns are yellow-white in color. The horn may be straight or curved and twisted, varying in size from few millimetres to several centimetres [3]. The treatment modality is surgical excision with macroscopic free margins and histopathology of the lesion [4].

Cutaneous horns should not be neglected and whenever encountered should undergo excision to exclude the possibility of malignancy especially at its base.

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2. Akan M, Yildirim S, Avci G, Akoz T. Xeroderma pigmentosum with a giant cutaneous horn. Ann Plast Surg 2001 Jun;46(6):665–6.   [CrossRef]   [Pubmed]    
3. Michal M, Bisceglia M, Di Mattia A, et al. Gigantic cutaneous horns of scalp: Lesions with a gross similarity to the horns of animals: A report of four cases. Am J Surg Pathol 2002 Jun;26(6):789–4.   [CrossRef]   [Pubmed]    
4. Oludiran OO, Ekanem VJ. Cutaneous horns in an African Population. J Cutan Aesthet Surg 2011 Sep;4(3):197–200.   [CrossRef]   [Pubmed]