various etiologies of cutaneous horn reported in literature till date111213 though cutaneous horns have been described in the literature for many years , they still remain novel to many clinicians especially when located in unusual areas like the genitalia . they usually appear in uncovered areas and/or from constant irritation over the scalp or face . it resembles the horn of an animal but has no bony structure inside . despite the typical appearance of cutaneous horn , there can be a wide range of pathology at the base ranging from benign , premalignant to malignant changes . a 47-year - old man presented with a raised painless growth over the prepuce for the last 4 months . twelve years ago , he was diagnosed with testicular seminoma of the right side . the tumor was excised , and six cycles of cisplatin - based chemotherapy were given . physical examination revealed a solitary , firm , nontender and well - circumscribed horn - like projection over the prepuce at 2 o clock position [ figure 1 ] . a clinical diagnosis of the penile cutaneous horn was considered , and a punch biopsy was performed . clinical image of cutaneous horn over the prepuce histopathological examination showed a raised lesion in the epidermis with hyperkeratosis , mounds of parakeratosis , focal hypergranulosis and marked irregular acanthosis with elongated [ figure 2 ] and inwardly curving rete pegs that enclosed several cavernously dilated thin - walled blood vessels within the papillary dermis [ figure 3 ] . a few of these blood vessels toward the base of the lesion showed fibrin thrombi . photomicrograph showing hyperkeratosis , papillomatosis , acanthosis and blood filled cavernous vessels in the papillary dermis ( h and e , 4 ) photomicrograph showing hyperkeratosis , papillomatosis and marked acanthosis with inwardly bending broad rete pegs enclosing cavernous blood vessels with fibrin thrombi ( h and e , 4 ) a diagnosis of solitary angiokeratoma presenting as the cutaneous horn was established based on the clinical presentation and histopathological findings . cutaneous horn ( cornu cutaneum ) is a clinical entity that appears as a conical protuberance over the skin surface and resembles a minuscule animal horn . they are of different shapes and sizes and can have satellite horns . by definition , it is a circumscribed conical markedly hyperkeratotic lesion in which the height of the keratotic mass amounts to at least half of its largest diameter . on the other hand , angiokeratoma has a pleomorphic appearance varying from papules , nodules , plaques which may be single or multiple . of the many clinical variants , solitary angiokeratoma represents an acquired disorder presenting as single warty papule . solitary angiokeratoma presenting as the cutaneous horn is a rarity , scarcely described in the literature . cutaneous horn could develop on a variety of skin conditions which can be benign , premalignant or malignant [ table 1 ] . a study analyzing 643 cases histopathologically had reported the most common causes for cutaneous horns to be benign ( 61.1% ) , followed by premalignant ( 23.2% ) and malignant ( 15.7% ) in that order . it was based on clinical appearance , apparent causation and histology [ table 2 ] . montgomery 's classification as of today , there is no precise clinical information to make a distinction of benign or malignant etiology for a cutaneous horn . in general , clinical pointers toward malignancy they are usually larger and harder at their base due to inflammation and are present at unusual sites such as genitalia . the presence of a malignancy elsewhere in the body supports the probability of cutaneous horn to be malignant . it is important to know the primary pathology which has led to the cutaneous horn to rule out malignancy and to direct prospective further therapy . the present case report highlights the presence of a solitary angiokeratoma as cutaneous horn over the prepuce , which has not been reported before . the present case report highlights the presence of a solitary angiokeratoma as cutaneous horn over the prepuce , which has not been reported before . the present case report highlights the presence of a solitary angiokeratoma as cutaneous horn over the prepuce , which has not been reported before .
we present a case of a 47-year - old man with 4 months history of conical growth on the prepuce with a progressive increase in size . 
 the patient had been treated for seminoma a decade ago . 
 histopathology of the growth showed features of angiokeratoma . 
 it is unusual for angiokeratoma to masquerade as a cutaneous horn .