Chondrodermatitis Nodularis Helicis in a 61-Year-Old Man

A 61-year-old man with a history of squamous cell carcinoma was concerned about a tender nodule on his ear. He complained of exquisite tenderness with pressure, such as when lying on the affected side at night.

Drs Charles E. Crutchfield III and Humberto Gallego of St Paul and Dr Eric J. Lewis of New London, Minn, suspected chondrodermatitis nodularis helicis, which was confirmed by a biopsy. This is a common, benign, painful lesion of the ear associated with fibrosis of the dermis and/or degeneration of the cartilage. The nodularity, rolled edge, central depression, and scale can mimic squamous cell and basal cell carcinomas.

The cause of chondrodermatitis nodularis helicis is unknown, although cold injury, actinic damage, and pressure necrosis have been suggested. The lesion can develop on any cartilaginous site on the lateral ear; the helix in men and the antihelix in women are the most common sites. Men are affected more often than women; two thirds of the patients are older than 60 years.

Skin cancer must be ruled out. Reserve treatment for patients with symptoms; surgery is commonly used and is effective. Special pillows-with cavities to accommodate the ear and prevent pressure, irritation, and pain-are available.