Most cutaneous horns arise from actinic keratoses and squamous cell carcinomas, so sun exposure and people with lighter complexions are more likely to be affected. Peak occurrence is from age sixty to mid-seventies.
About 50% of the time, what is at the base is benign; however, malignancy has been reported at the base in up to 20% of lesions (usually squamous cell carcinoma). In another 23–37% of cases, premalignant actinic keratoses are at the base. It is critical to determine the histology of the underlying lesion, as no clinical features reliably distinguish between benign and malignant lesions.