Photo Rounds

Nodule on ear

A 44-year-old man sought care for a painful nodule on his right ear. The nodule had been there for a year, and the patient had a long history of occupational sun exposure--but no skin cancers. The patient told his family physician (FP) that he found it too painful to sleep on his right side because of the ear nodule. He tried to remove it once with nail clippers, but it bled too much.

What’s your diagnosis?


 

The FP told the patient that this was likely a benign condition called chondrodermatitis nodularis helicis. A shave biopsy/removal was performed to confirm the diagnosis and to rule out skin cancer. The biopsy confirmed the FP’s suspicions.

Chondrodermatitis nodularis helicis is a benign neoplasm of the ear cartilage that is believed to be related to excessive pressure during sleep. The result is a localized overgrowth of cartilage and subsequent skin changes. It is more commonly seen in men. The helix is most often affected in men and the antihelix in women.

Treatment options include cryosurgery, intralesional steroid injection, electrodesiccation, and curettage and elliptical excision. Less aggressive treatment options (cryosurgery and intralesional steroids) tend to be less successful.

If a patient does not want surgery, a pressure-relieving prosthesis or donut-shaped pillow can be used. Patients can create such a prosthesis by cutting a hole from the center of a bath sponge. The sponge can then be held in place with a headband, if needed.

In this case, elliptical excision including curettage of the involved cartilage was used to treat the patient, with excellent results.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: French L. Chondrodermatitis nodularis helicis and preauricular tags. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:189-192.

To learn more about the Color Atlas of Family Medicine, see: http://www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/ref=dp_ob_title_bk

You can now get the second edition of the Color Atlas of Family Medicine as an app for mobile devices by clicking this link: http://usatinemedia.com/

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