American Board of Family Medicine (ABFM) Practice Exam

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What skin lesion resembles actinic keratosis but features a horn-like projection?

  1. Basal cell carcinoma

  2. Cutaneous horn

  3. Squamous cell carcinoma

  4. Keratoacanthoma

The correct answer is: Cutaneous horn

The correct answer is a cutaneous horn. This type of lesion is characterized by an elevated protrusion resembling a horn, typically composed of compacted keratin. While it can resemble other conditions like actinic keratosis due to its appearance, cutaneous horns are distinct because their formation is a consequence of excessive keratin production. In contrast, basal cell carcinoma can present in various forms but does not specifically feature a horn-like projection. Similarly, squamous cell carcinoma is a more aggressive skin lesion that may appear as a firm, scaly, or ulcerated area but typically does not take on the characteristic elongated, keratin-rich structure of a horn. Keratoacanthoma, while it can superficially resemble a cutaneous horn, is generally a benign and self-limiting condition that usually presents as a dome-shaped nodule rather than a distinct horn-like protrusion. Therefore, the cutaneous horn is uniquely identified by its appearance and the specific nature of its keratin formation, making it the answer to the question.