Penile cutaneous horn: still an enigma
The present case has been reported in BMJ. A 60-year-old man with history of Johanson’s staged urethroplasty for pan anterior urethral stricture due to lichen sclerosus et atrophicus 3 months previously presented with a cutaneous horn over his glans penis.

This horn was previously excised superficially, and now had recurred over the same site in the last 1 month. It was initially small in size and then gradually increased to a size of around 2.5 cm. The patient had no documents mentioning the histopathology of previously excised horn. The patient had been circumcised in childhood. He had no history of genital malignancy or other factors that could have been implicated in cutaneous horn formation.

He was managed with excision of the horn along with deep biopsy from base of the lesion to rule out any malignant pathology. The excision site healed well, and biopsy revealed benign pathology. At present, patient has no persistent changes in glans/penile shaft related to lichen sclerosus et atrophicus, and he is on regular follow-up.

Learning points
• Penile cutaneous horn may recur and demonstrate malignant change on repeat biopsy even when initial histology is benign.

• Patient’s apprehension should be alleviated and properly counselled regarding recurrence and bothersome sexual life.

• As cutaneous horn may originate from underlying malignancy, patient should be kept on close follow-up.

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