Although Koda Rohan was known for his realistic fiction, "Encounter with a Skull" (1890, Taidokuro) is an all-out horror tale. The narrator encounters more than just a skull in an eerie mountain setting. While reminiscent of Lafcadio Hearns ghostly tales, the realistic tone and the grisly description give this tale unusual impact. A true horror tale in the Western sense of the word.

It is a gripping union of old Japanese terror told in a very modern style. Using the time-honored technique of the haunted refuge for unwary travelers, his narrative creates a convincing sense of mystery and awe. The horror at the end is gruesome but somehow tinged with mysticism. Rohan's translator and critic, Chieko Mulhern wrote that:

Its structure is reminiscent of Noh plays, in which the protagonist undergoes metamorphosis, usually from a humble disguise to the spirit of a dead nobleman suffering because he is still undelivered from his former self, revealing the pathos of this world and visions of life after death.
The story's hero, a Buddhist monk also named Rohan, wandering lost in the mountains meets a beautiful young woman who invites him to spend the night in her cabin. Not wishing to succumb to lustful temptations, he tries to stay awake by listening to her tell her life story. She has an unnamed curse that precluded her having a normal life of home and family. In the morning she and her cabin vanished without a trace, except for her clean, white skull.

Rohan learns from a local innkeeper that he had met the ghost of a leper girl who recently died. He imagines a terrible vision of her bodily decay, a warning against the consequences of lust and a reminder of the transience of life. The innkeeper describes her in horrific detail:

...her face was even more horrible, looking like a half-melted copper-lion. With all the eyebrows gone, the prominent forehead was marred by deep hollows filthier than faded purple rubbed with ditch mud, oozing yellowish grey pus like rotten oysters pouring out of the shells Her hairless head glistened weirdly like a well-polished red gourd Her right eye was merely a red crater,

Mulhern compares Rohans horrid description of leprous decay to the Japanese medieval depictions known as the Disease Scroll (yamai-zoshi) and the Hell Scroll (jikoki zoshi)