Cutaneous horns are uncommon in adults and rare in the pediatric population. Although verruca vulgaris, solar keratosis, and squamous cell carcinoma are more common entities that can present as cutaneous horns in the general population, conditions such as molluscum contagiosum, juvenile xanthgranuloma, and pyogenic granuloma have been reported causes in the pediatric population. We present a case of a perforating pilomatricoma presenting as a cutaneous horn in an 11 year old girl.