|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 4 | Page : 449
Penile cornu cutaneum with squamous cell carcinoma
Tejinder Kaur1, Sumitoj Singh2, Rajwinder Singh1, Varun Aggarwal2
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 Publication||1-Feb-2016|
Dr. Tejinder Kaur
Department of Dermatology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab
Source of Support: None, Conflict of Interest: None
|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
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.
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. The incidence of squamous cell carcinoma increases to 33% in patients with penile cutaneous horn  Some authors consider all penile horns to be premalignant. A large size and tenderness at the base favor malignant potential. The macerating effect of the moisture under the foreskin prevents the formation of penile horns, thus explaining its development following circumcision. 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.
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