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Diagnosing a Cutaneous Horn on an Elderly Woman’s Face


Annals of Long-Term Care: Clinical Care and Aging. 2014;22(10):17-19.


I-Chiang Shy, MD, MA 1; Ching-Yun Han, MD 2


1Department of Family Medicine, Kuang-Tien General Hospital, Taichung, Taiwan

2Department of Family Medicine, Lin-Shin Hospital, Taichung, Taiwan

A 95-year-old woman who resided in a long-term care facility presented with a horn-like lesion on her face. She said that the skin lesion had grown slowly for at least 1 year, during which time she was asymptomatic. She had no family or personal history of cutaneous tumors. She sought medical evaluation for pain under the lesion, which began a few days prior to her current presentation. A physical examination revealed a firm, yellow-gray cutaneous horn on her left cheek, approximately 1.5 cm long with an erythematous base (Figure 1). The remainder of the examination did not show any other abnormalities. There was no associated lymphadenopathy on palpation. The lesion was completely excised with safety margins. A pathohistological examination showed massively compact keratin layers and proliferation of atypical keratinocytes confined to the epidermis.

figure 1

Based on the patient’s history, physical examination, and photograph, what is your diagnosis?

A.  Acrochordon

B.  Basal cell carcinoma

C.  Actinic keratosis

D.  Seborrheic keratosis

E.  Nongenital wart

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