Photo Rounds

Growth behind infant’s ear

An infant was in the office for his 4-month well-child exam and vaccinations when his mother asked the family physician (FP) why the skin behind the infant’s ear looked different. She said that it began to look different about 2 months ago. She did not think that it was causing her son any pain or discomfort. The child was otherwise healthy and met all growth and developmental milestones.

What’s your diagnosis?


The FP recognized the growth as an early nevus sebaceous (NS).

NS may be present at birth or noted in early childhood and occurs in males and females equally. In early stages of development, it appears skin-colored and waxy. Because of the potential for malignant transformation, particularly following puberty, many authors have recommended early complete plastic surgical excision. However, in a retrospective analysis of 757 cases of NS from 1996 to 2002 in children <16 years, investigators found no malignancies and questioned the need for prophylactic surgical removal.

The FP emphasized that this condition was benign and would likely get darker and more raised over time. He said that he would keep an eye on it during future visits and that the boy could choose to have it removed when he became an adult. The FP explained that reasons for removal include cosmetic issues and the prevention of malignant changes.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Epidermal nevus and nevus sebaceous. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine, 2nd ed. New York, NY: McGraw-Hill; 2013:958-962.

To learn more about the Color Atlas of Family Medicine, see:

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link:

Next Article: