An 84-year-old man with a history of skin cancer of the left auricle that had been treated at an outside institution was noted to have an indurated, fixed nodule over the right mastoid process during a routine dermatologic follow-up. He reported that it had been present for 8 months. His medical history included Paget disease, left auricular squamous cell carcinoma, and coronary artery disease, with a 1-year history of coronary artery bypass grafting. He smoked and drank occasionally.