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Journal of Postgraduate Medicine, Vol. 55, No. 4, October-December, 2009, pp. 287 Images in Clinical Medicine Penile cutaneous horn over long standing radiation dermatitis Nayyar R, Singh P, Seth A Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India Correspondence Address: Dr. Amlesh Seth, Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India, amlesh.seth@gmail.com Code Number: jp09091 PMID: 20083880 DOI: 10.4103/0022-3859.58937 A 70-year old male was diagnosed with squamous cell carcinoma of glans penis, 12 years back. The lesion was 1 cm in size for which circumcision and local radiotherapy were prescribed and good functional results were obtained. Over the last 6 months, the patient noticed a small growth over the glans, which was gradually increasing in size. On examination, there was a 5 cm j-shaped horn-like keratinized growth on the right side of corona of penis with no inguinal lymphadenopathy [Figure - 1]. The glans was hypopigmented with thick non-pliable skin over distal shaft due to previous radiotherapy. There was a large left hydrocele. Systemic examination was normal. The entire lesion was excised with 5 mm margins along with a separate biopsy from the base of lesion. Histopathological examination revealed features of cutaneous horn with underlying well-differentiated squamous cell carcinoma. Margins and deep biopsy were free of tumor. Features of chronic radiodermatitis were evident in adjacent skin. A partial penectomy was advised in view of malignancy. However, the patient preferred to remain under close follow-up. Cornu cutaneum (cutaneous horn) refers to a well-defined cone-shaped lesion with hyper-keratotic features. It usually occurs on sun-exposed areas and rarely on penis. [1] Lesions underlying a cutaneous horn are usually benign like wart, naevus, trauma, burn, lupus vulgaris, etc. However, one third of cases may have underlying malignancy such as squamous cell carcinoma, basal cell carcinoma, granular cell tumour, sebaceous carcinoma or Kaposi's sarcoma. [2] Therefore, treatment consists of surgical excision with a margin of normal tissue and careful histopathological examination of the base of tumor. [1] If malignancy is present in a penile cutaneous horn, the treatment involves partial penectomy with or without regional lymph node dissection. [3] Therapy with carbon dioxide or neodymium YAG laser is used for patients who refuse surgery or not fit for surgery. Penile cutaneous horns are prone to recur after excision and may demonstrate malignancy on subsequent biopsy. Therefore, close follow up of these patients is essential. Our case was very unusual on two accounts. First, it occurred as a manifestation of underlying recurrent malignancy and secondly it occurred after a lag time of 12 years after radiotherapy for squamous cell carcinoma at same site. To our knowledge, previously only one such case has been reported in literature where cutaneous horn occurred over a long standing chronic radiodermatitis after 5 years of radiotherapy. [4] The long gap of 12 years in our case suggests the etiological role of chronic dermatitis in the development of recurrent squamous cell carcinoma and the cutaneous horn rather than the recurrence of primary disease. However, exact cause and effect relationship cannot be established given the rarity of the disease. References
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