Cutaneous Horn Workup

Updated: Oct 09, 2017
  • Author: Patrick S Rush, DO; Chief Editor: William D James, MD  more...
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Workup

Laboratory Studies

Determination of the histology of the underlying lesion is crucial to rule out malignancy and to determine proper follow-up, as no reliable clinical features clearly delineate the etiology of the lesion at the base of the horn. Diagnosis is confirmed with a skin biopsy. An adequate specimen usually can be obtained with a simple shave biopsy. The specimen must be of sufficient depth to ensure that the base of the epithelium is obtained for histologic examination.

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Histologic Findings

The horn is composed of compact hyperkeratosis, which may be either orthokeratotic or parakeratotic in nature, as shown in the image below.

Medium power view of the mixed hyperparakeratosis Medium power view of the mixed hyperparakeratosis and hyperorthokeratotic keratin that makes up the actual horn (hematoxylin and eosin [H&E] stain, original magnification 20x).

Associated acanthosis is a common finding. The base will display features of the pathologic process responsible for the underlying lesion, as shown in the image below. [30, 36]

Low power view of a cutaneous horn overlying an ac Low power view of a cutaneous horn overlying an actinic keratosis (hematoxylin and eosin [H&E] stain, original magnification 20x).
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