A 76-Year-Old Man with a Lesion of the Right Ear

Introduction. A 76-year-old man reported right ear pain of more than 2 weeks’ duration that began while he was at the beach during the summer.

History. The patient believed the pain might be from an ingrown hair but approaches to relieving the pain were ineffective. A distinct lesion then formed on the tragus area and grew rather quickly to approximately 1 cm. He took a cell phone picture of the lesion and noted it had the appearance of a small volcano with a whitish material in its cone. Over the ensuing months, the lesion waxed and waned but would not totally resolve. Into the winter, the lesion increased in size. At presentation, the lesion had a heaped up, nodular area as well as a tendency to easily bleed.

The patient is otherwise healthy with only mild essential hypertension as a chronic disease that is well-controlled with an angiotensin inhibitor and diuretic. His history includes the removal of several basal cell carcinomas by standard wedge resection, as well as the removal of melanoma on his back from 10 years prior. The patient is a retired intensive care unit nurse. He has had a significant sun exposure history dating back to boyhood on the ballfields and golfing at least twice weekly. He lives in Pennsylvania and vacations yearly at the New Jersey shore.

His physical examination reveals a well-appearing man with light brown hair and green eyes. He has a 1-2 cm erythematous, crusting lesion with small but definite heaped up nodular margins. The lesion bleeds easily with any probing or manipulation and no longer resembles a volcano with a crater. There is no local or regional lymphadenopathy. He has light skin and his forearms and hands are quite freckled.