Background: Cutaneous horn is a clinical term used to describe a hard, keratotic conical lesion. Its base may be a papule, plaque or nodule. Objectives: An approach for how to diagnose and manage a cutaneous horn. Materials and methods: Here-in we report an aged male 85-years old presented with a history of painful slowly progressive skin lesion over his right foot 7 months ago. Results: The past medical history revealed that the lesion was preceded by presence of a cutaneous horn (CH) at the same site of the current skin lesion. That CH was persistent for a year before it spontaneously fell down. Skin biopsy from the base of the CH was taken at that time, it was consistent with underlying actinic keratosis. He did not receive any treatment for his CH. Currently skin examination revealed fungating ulcer measuring 6X6 cm on the dorsum of the right foot. There was no inguinal lymphadenopathy. Punch skin biopsy was taken from the edge of the ulcer for histo-pathological examination. Conclusion: On the basis of the above clinicopathological findings, a diagnosis of well differentiated Squamous Cell Carcinoma was made. The patient was referred to Oncologist for appropriate management.