What should you know about horned actinic keratosis?

The horn is made of compacted keratin, the protein in the outer layer of skin. It may sit on a rough, scaly or discoloured base on sun-exposed skin such as the face, ears, scalp, forearms or backs of hands. The surface can resemble a harmless wart or thick scale, but its appearance alone cannot distinguish an actinic keratosis from an early Squamous Cell Carcinoma or another growth. Sun-Damaged Skin increases the need for careful examination.

Do not cut, file or pick the projection at home. Arrange a skin examination; the clinician may feel the lesion, inspect its base and decide whether a sample or removal is needed. Treatment options can include Cryotherapy (Lesion Removal) for selected isolated lesions, or field treatments such as Topical 5-Fluorouracil, Imiquimod Treatment or Photodynamic Therapy when surrounding sun-damaged skin also needs attention. Skin Cancer Screening may help assess other areas.

Seek a prompt dermatology appointment if the growth is tender, thickening, bleeding, crusting, ulcerating or enlarging, or if it does not heal. Pain at the base and rapid change deserve particular attention. Do not wait for a horn to fall off before seeking advice: the underlying skin may still require diagnosis and treatment. New lesions on chronically sun-exposed skin should also be recorded and examined.

Ask whether the base needs a biopsy, which treatment fits the lesion and nearby skin, how wound care should be handled, and how often your skin should be checked. Mention previous skin cancers, immune-suppressing medicines and any change noticed since the lesion appeared.