Microscopically, the specimen showed marked hyperkeratosis, parakeratosis, and marked acanthosis. An area at the base of the horn revealed squamous cell atypia, although no evidence of squamous cell carcinoma was found on deep biopsies of the circumferential skin surrounding the base of these lesions. The etiology of penile horns is unclear, although their association with and histological resemblance to condylomata acuminata suggest that they are a particularly striking form of this more familiar lesion. Malignant change should always be suspected in such fast-growing lesions but, as our case demonstrates, it is not invariably present. Clinically, the penile horn may produce pain, irritative symptoms, dysuria and interference with sexual intercourse.
Ulceration is uncommon.
Malignant changes have been noted in 12 of the approximately 100 reported cases, with such lesions exhibiting all of the characteristics of penile carcinomas. We believe that wide local excision should be the initial treatment, with deep biopsies of the skin surrounding the base of the lesion for accurate histological diagnosis. YAG laser therapy have been reported by many authors for condylomata acuminate. Large lesions usually require more than 1 treatment session but the lesser degree of scarring with superior cosmetic results make laser therapy attractive. Because of the size of these lesions, podophyllin effective against condylomata probably is not appropriate.