Background: Cutaneous horns usually develop on a keratinocytic base with the histopathology on a spectrum ranging from benign keratosis through to invasive squamous cell carcinoma (SCC). Some features of horns are easily identified using dermatoscopy.
Objective: To investigate if specific clinical or dermatoscopy features of horns correlate with the histopathology in the base of the horn.
Methods: Consecutive horn cases (n=163) were assessed prospectively in vivo for horn height, terrace morphology and base erythema using a Heine Delta 20 dermatoscope. Cases with potentially confounding influences were excluded. A history of horn pain or pain on palpation was also recorded.
Results: Benign keratosis (n = 49), actinic keratosis (n = 21), SCC in situ (n = 37) and invasive SCC (n = 56) were recorded. An invasive SCC presenting as a horn as most likely to have a height less than the base diameter, 66% (37/56). Compared to the other study entities, invasive SCC tends to have less terrace morphology (P<0.05), a higher incidence of base erythema (P<0.05) and more pain (P<0.01).
Limitations: Data categories did not include anatomic site or horn growth rates. Excision selection bias favored the incidence of invasive SCC.
Conclusions: Horns presenting on an invasive SCC base are more likely to have a height less than the diameter of the base, not to have terrace morphology, to have an erythematous base and to be painful.

/pdf/cutaneous-horns-clues-to-invasive-squamous-cell-carcinoma-11qmv01dsu.pdf

Cutaneous horns: clues to invasive squamous cell carcinoma being present in the horn base.

A 73-year-old Japanese woman presented with cutaneous horn on the right cheek. The resected tumor was 9 mm in diameter, with 14 mm protrusion, and showed exophytic growth with marked papillomatosis. Histopathology showed proliferation of atypical melanocytes with melanin pigments in the epidermis and dermis under the cutaneous horn. These cells were confined to the base of the cutaneous horn, and did not spread to the surrounding epidermis. The final diagnosis was cutaneous horn malignant melanoma. This pathological entity is considered a specific form of verrucous melanoma, and might be added to the list of cutaneous horn-forming lesions.

/pdf/cutaneous-horn-malignant-melanoma-5ebgsfq2p5.pdf

Cutaneous horn malignant melanoma

Cutaneous horns were first reported in London in 1588.1 Unlike a true animal horn that has bony core, a cutaneous horn is a conical projection made up of cornified material. The length of this lesion varies from a few millimeters to 38 cm in some reported cases.2 Cutaneous horns are usually skin colored or erythematous, and they may present as white with a fine scale.3 Approximately 30% of cutaneous horns appear in sun-exposed areas, such as upper face and scalp.1 However, chronic irritation can also give rise to cutaneous horns on other areas of the body, even on the penis.4 People ages 50 to 89 years are the group most affected.5 Cutaneous horns are a morphologic designation rather than a pathologic diagnosis, and they can be derived from many benign or malignant diseases, such as seborrheic keratoses, basal cell carcinoma, and squamous cell carcinoma (SCC).

https://www.jaadcasereports.org/article/S2352-5126(15)00100-9/pdf

A giant cutaneous horn on the eyebrow.

Cutaneous horns are usually found on skin surfaces exposed to high levels of sunlight.It is a rare tumor presenting as a conical, well-circumscribed mass, and is usually composed of dead keratin.Cutaneous horns may originate from a wide spectrum of skin lesions including those that are benign, premalignant, or malignant.We are reporting a rare case of Actinic keratosis presenting as a slow-growing "horn-like" mass over the patient's left ear pinna.Excision biopsy was performed and histopathology confirmed the diagnosis.Cutaneous horn is a rare clinical entity, with a bizarre horn-like growth commonly appearing at sun-exposed areas of the head and neck region.However, such a lesion can also originate from a benign, premalignant, or malignant condition; therefore, excision with histopathological studies is mandatory in all cases. 

Actinic Keratosis Masquerading as a Cutaneous Horn

Cutaneous horn is the clinical description of a hyperproliferation of compact keratin in response to a wide array of underlying benign and malignant pathologic changes. This case report describes a cutaneous horn with an underlying squamous cell carcinoma in a 70 year old male. Grossly the mass was measuring 7X7 cm, yellow - brown in colour, hard in consistency. The lesion was totally excised and sent for histopathological examination. Histopatholgically, it was reported as invasive squamous cell carcinoma with cutaneous horn.

https://www.ijmhs.net/articles/1397657163Invasive_Squamous_Cell_Carcinoma_Underlying_Cutaneous_Horn_A_Brief_Case_Report.pdf

Invasive Squamous Cell Carcinoma Underlying Cutaneous Horn â€“ A Brief Case Report

Cutaneous horn is the clinical description of a hyperproliferation of compact keratin in response to a wide array of underlying benign and malignant pathologic changes We report here on a case of cutaneous horn that originated from keratoacanthoma in a 76-year-old woman Grossly, a 25×07 cm sized yellow-white colored scaly fungating mass from an erythematous nodule was observed on the right temporal area Histopathologically, it was reported as keratoacanthoma with cutaneous horn The lesion was totally excised after the diagnosis

A case of cutaneous horn originating from keratoacanthoma.

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A case of cutaneous horn originating from keratoacanthoma.