A 20-year-old Native American man presented with a 13 × 8-cm disfiguring, exophytic postauricular mass (Figure 1) spanning from the right superior helix down to the nape of his neck. This mass reportedly began 4 years prior as recurrent papules and pustules that grew larger and coalesced. Two prior surgical excisions by a local physician and treatment with triamcinolone acetonide injections in combination with short courses of isotretinoin were unsuccessful. Cultures were negative for infectious organisms. The mass was widely excised, and the site was closed with a split-thickness skin graft harvested from the thigh.
Miller RA, Spanos WC, Jassim AD. Pathology Quiz Case 2. JAMA Otolaryngol Head Neck Surg. 2013;139(4):425. doi:10.1001/jamaoto.2013.140a