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Clinical Challenge
May 2015

A Man With Painful Nodules on Both Ears

Author Affiliations
  • 1Department of Pathology, Government Medical College and Hospital, Chandigarh, India
  • 2Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
JAMA Otolaryngol Head Neck Surg. 2015;141(5):481-482. doi:10.1001/jamaoto.2015.0260

A man in his 40s presented with a 2-year history of a few small painful nodules on both ears. The nodules were painful on touch, especially while the patient was sleeping in a lateral position. There was no history of trauma. However, he used to wear a cap, which created pressure and friction on the upper part of both ears. On examination, the free border of the helix of both the ears showed a few dull red, dome-shaped, firm nodules 2 to 3 mm in size with central crusting (Figure, A). They were tender on palpation. No cervical lymphadenopathy was observed. One of the nodules on the right ear was excised; histopathologic features of the nodule are shown in the Figure, B. It showed a sharply defined, centrally depressed ulcer covered by a hyperkeratotic parakeratotic scale, occasional bacterial colonies, and plasma. The adjacent epidermis showed hyperplasia. The base of ulcer showed eosinophilic degeneration of collagen and solar elastosis. In addition, there were a few proliferating blood vessels and mild lymphomononuclear infiltrate. Underlying cartilage was not seen in the section. On serial sectioning, cartilage was seen and found to be normal.

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