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LETTER TO THE EDITOR
Year : 2014  |  Volume : 51  |  Issue : 4  |  Page : 449
 

Penile cornu cutaneum with squamous cell carcinoma


1 Department of Dermatology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
2 Department of General Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

Date of Web Publication1-Feb-2016

Correspondence Address:
Dr. Tejinder Kaur
Department of Dermatology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175336

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How to cite this article:
Kaur T, Singh S, Singh R, Aggarwal V. Penile cornu cutaneum with squamous cell carcinoma. Indian J Cancer 2014;51:449

How to cite this URL:
Kaur T, Singh S, Singh R, Aggarwal V. Penile cornu cutaneum with squamous cell carcinoma. Indian J Cancer [serial online] 2014 [cited 2019 Dec 6];51:449. Available from: http://www.indianjcancer.com/text.asp?2014/51/4/449/175336


Sir,

A 65-year-old man presented with a hard growth over the penis that had continuously recurred over the past 20 years. He had undergone circumcision 20 years previously for an unstated reason. A few months later, he developed a hard growth over the penis, which slowly increased in size. There was no history of any kind of lesion prior to the appearance of this growth. The patient used to keep the lesion moist by wearing wet underpants because the lesion used to shed off after keeping it moist for few days. There were several episodes of complete shedding of the growth leaving no lesion behind at that site. The regrowth used to occur in the form of hyperkeratotic lesion at the same site within few months. Patient never took consultation from any physician for this complaint. No other significant history was noted, and general physical examination yielded normal results. Cutaneous examination revealed non-tender, generally immobile, yellowish, elongated, keratotic growth measuring 5 cm × 3 cm protruding from the dorsal part of the glans penis [Figure 1]. The surrounding skin was slightly hypopigmented with no inflammation or induration at the base. There was no inguinal lymphadenopathy, and all routine investigations revealed normal findings. Ultrasonography showed no inguinal and pelvic lymphadenopathy. Excisional biopsy including the base of the lesion revealed epidermal proliferation with a circumscribed deeper border. The proliferation consisted of thickened branching and coalescing rete ridges. Occasional keratinocytes showed individual cell keratinization but there were no horn pearls. Lower 1/3rd of the epidermal proliferation showed crowding of keratinocytes with altered nuclear cytoplasmic ratio with increased mitotic figures above the basal layer. The dermoepidermal junction was well maintained. The dermis showed moderately dense lymphoplasmocytic infiltrate. Upper stratum corneum showed pallor of keratinocytes. Thus diagnosis of squamous cell carcinoma on histopathological examination was made, and partial penectomy was subsequently performed.
Figure 1: Cornu cutaneum on the dorsal surface of the glans penis

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Cornu cutaneum or cutaneous horn is a clinical term for conical protruding hyperkeratosis. Only few hundred cases of penile horn have been reported thus far. They usually arise secondary to chronic inflammation or other dermatoses. The associated conditions are benign in 42-56%, premalignant in 22-37%, and malignant in 20-22% cases.[1] The incidence of squamous cell carcinoma increases to 33% in patients with penile cutaneous horn [1] Some authors consider all penile horns to be premalignant.[2] A large size and tenderness at the base favor malignant potential.[3] The macerating effect of the moisture under the foreskin prevents the formation of penile horns, thus explaining its development following circumcision.[4] In our case, although the patient's age and the large size of the lesion favored malignant potential, the history of complete remission and relapse could not explain its malignant nature.

Because these lesions are associated with a high risk of malignancy, wide excisional biopsy at the base is indicated in every case of penile horn. In case of malignancy, the penile horn should be treated in the same manner as any other case of penile cancer.

 
  References Top

1.
Lowe FC, McCullough AR. Cutaneous horns of the penis: An approach to management. Case report and review of the literature. J Am Acad Dermatol 1985;13:369-73.  Back to cited text no. 1
    
2.
Pizzocaro G, Algaba F, Horenblas S, Solsona E, Tana S, Van Der Poel H, et al. EAU penile cancer guidelines 2009. Eur Urol 2010;57:1002-12.  Back to cited text no. 2
    
3.
Tauro LF, Martis JS, John SK, Kumar KP. Cornu cutaneum at an unusual site. Indian J Plast Surg 2006;39:76-8.  Back to cited text no. 3
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4.
Bart RS, Kopf AW. On a dilemma of penile horns: Pseudoepitheliomatous, hyperkeratotic and micaceous balanitis? J Dermatol Surg Oncol 1977;3:580-2.  Back to cited text no. 4
    


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