A 5-year-old girl presented with skin colored to whitish raised skin lesions over the face, hands and trunk of three months duration. She also had watering, pain and redness of the left eye. Her parents had expired due to AIDS. On examination, she was asthenic with generalized lymphadenopathy. Cutaneous examination revealed multiple, shiny, whitish to skin colored, umbilicated papules (typical of molluscum contagiosum), some of them were more than 2 cm in size. On puncturing, these lesions expressed cheesy white material. They were distributed bilaterally asymmetrically over the face, hands and trunk. A solitary firm horn like projection, 1 cm in height was seen originating from the left upper eyelid from a molluscum contagiosum lesion (Fig. 1). She was diagnosed as having molluscum contagiosum and cutaneous horn. She also had a positive serology for HIV. The skin lesions were treated with extirpation and trichloroacetic acid cautery.

Fig 1. Left eyelid margin showing a cutaneous horn and adjoining skin having an infected molluscum contagiosum lesion.

Cutaneous horn (cornu- cutaneum) is the term coined for horny skin excrescence, which in its form and consistency resembles an animal horn in miniature. The paramount consideration while making a clinical diagnosis is the height of the keratotic mass (at least one half of its largest diameter). The important issue is not the horn itself which is dead keratin, but rather the underlying condition, which may be benign (seborrheic keratosis, viral warts, histiocytoma, inverted follicular keratosis, verrucous epidermal nevus, molluscum contogiosum, etc.), premalignant (solar keratosis, arsenical keratoses, Bowen’s disease) or malignant (squamous cell carcinoma, rarely, basal cell carcinoma, metastatic renal carcinoma, granular cell tumor, sebaceous carcinoma or Kaposi’s sarcoma). Most commonly, they are single and arise from a seborrheic keratoses lesion. They are encountered most frequently on the face and scalp, but may occur on the hands, penis and eyelids.

Devender Mohan Thappa,
Chandrashekhar Laxmisha,
Department of Dermatology and STD,|
Jawaharlal Institute of Postgraduate Medical
Education and Research (JIPMER),
Pondicherry 605 006, India.
E-mail: [email protected]