Painful Skin Nodules

Figure

Q. An 81-year-old man presented with painful, indurated nodules on his ear (Figure). What's the most likely diagnosis?

A. Actinic keratosis

B. Chondrodermatitis nodularis helicis chronica

C. Basal-cell carcinoma

D. "Cauliflower ear" from old trauma

See the Answer.

C. Diagnosis: Basal-cell carcinoma. This pearly, indurated lesion with prominent telangiectasia in a sun-exposed area has the characteristic features of a basal-cell carcinoma, the most common form of skin cancer. Chronic trauma with auricular hematoma formation results in distortion of the cartilage, which this patient does not have. The painful nodules on the rim of the ear, called chondrodermatitis nodularis helicis chronica, typically appear on the anterior pressure points of the ear and are dome-shaped, with central crusts or keratin-filled craters. The surface of this patient/s ear is smooth, stretched, and shiny?unlike the rough keratotic surface of an actinic keratosis. Biopsy confirmed basal-cell carcinoma, which was cleared with radiation therapy.