Keratoacanthoma associated with cutaneous horn: a case report

Introduction: Keratoacanthoma is an epithelial keratinocytic benign tumor. A cutaneous horn is a conical projection of hyperkeratotic epidermis. Keratoacanthoma presenting as a cutaneous horn is rare. Histopathological examination is essential to rule out malignancies, such as squamous cell carcinoma (SCC). Case presentation: A 70-year-old female patient presented with a progressively enlarging horn-like lesion on the left cheek. The lesion had rapidly increased in size over the preceding 3 months. Although the lesion was painless, the patient sought evaluation for the progressive enlargement, risk of malignant transformation, and the need for definitive diagnosis and treatment. Given the clinical suspicion of keratoacanthoma with the possibility of an underlying malignancy such as SCC, complete surgical excision was performed. Histopathological examination confirmed keratoacanthoma. The patient demonstrated satisfactory wound healing without recurrence during the 6-month follow-up period. Clinical discussion: The presented case is rare and closely resembles malignant cutaneous lesions. This case emphasizes the importance of correlating clinical findings with histopathology to establish an accurate diagnosis and guide the surgical approach. Conclusion: Keratoacanthoma associated with a cutaneous horn is an uncommon clinical entity that closely mimics SCC. First, all cutaneous horns should undergo histopathological examination because the underlying lesion cannot be reliably determined clinically. Second, complete surgical excision offers both therapeutic and diagnostic value. Third, early recognition and timely intervention may prevent delayed diagnosis of potentially malignant lesions and improve patient outcomes.