Photo Quiz

Posterior Earlobe Mass

 

Am Fam Physician. 2018 Nov 15;98(10):603-604.

A 23-year-old man presented with a painless mass behind his right earlobe that had been present for one year (Figure 1). He initially noticed a flesh-colored, pinpoint growth on both sides of his earlobe after wearing a fake hoop earring that compressed his earlobe. Although the changes on the front of the earlobe resolved, the posterior mass gradually increased in size. There was no pain, itching, or bleeding.

On physical examination, there was a mass measuring 1.5 × 2 cm on the posterior aspect of his right earlobe. There were no skin changes, although small blood vessels could be seen extending into the lesion. On palpation, the mass was slightly firm, nontender, and nonpulsatile, and it did not transilluminate.

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FIGURE 1


FIGURE 1

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Acrochordon.

B. Epidermal inclusion cyst.

C. Hypertrophic scar.

D. Keloid.

Discussion

The answer is D: keloid. The earlobe is a common site for keloids, which are benign dense growths of disorganized collagen fibers that occur in response to skin trauma. Keloids can extend beyond the border of the initial injury, have delayed appearance, and grow indefinitely, and they often regrow after removal.1 Auricular keloids occur with 2.5% of all ear piercings.2 Keloid removal can be challenging because of the potential for disfigurement or further scarring. Keloids most often affect persons 10 to 30 years of age.2

Treatment options are varied and include excision, intralesional corticosteroids, excision combined with corticosteroid injection, cryotherapy, silicone sheeting, pressure dressings, immunosuppressive or antitumor agents, pulsed dye laser treatment, and radiation therapy. Rate of recurrence for excisional removal varies widely, with case studies reporting rates of 50% to 100%.1 Recurrence is reduced to 10% to 50% when excision

Author disclosure: No relevant financial affiliations.

Address correspondence to Luci Olewinski, MD, at luci_olewinski@med.unc.edu. Reprints are not available from the authors.

References

show all references

1. Sobec R, Dobreanu C, Fodor L, Şomcutean A, Ţichil I, Cosgarea M. Ear keloids: a review and updates of treatment options. Clujul Med. 2013;86(4):313–317....

2. De Sousa RF, Chakravarty B, Sharma A, Parwaz MA, Malik A. Efficacy of triple therapy in auricular keloids. J Cutan Aesthet Surg. 2014;7(2):98–102.

3. Higgins JC, Maher MH, Douglas MS. Diagnosing common benign skin tumors. Am Fam Physician. 2015;92(7):601–607.

4. Lee JA, Khodaee M. Enlarging, pedunculated skin lesion. Acrochordon. Am Fam Physician. 2012;85(12):1191–1192.

5. Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am Fam Physician. 2009;80(3):253–260.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

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