Well-Differentiated Squamous Cell Carcinoma

A 1-cm, tan-brown lesion had developed years earlier at the posterior helix of a61-year-old man's right ear. Central ulceration and crusting were noted on thepapule. The patient sought medical evaluation when the lesion became nodularand began to flake.The lesion was excised; pathologic examination identified a well-differentiatedsquamous cell carcinoma. The neoplasm extended to the deepest marginof the excision; all other margins were free of tumor.The cancer had developed in an actinic solar keratosis with clearly evidentbasophilic degeneration of dermal collagen attributed to sun exposure. The patienthad worked outdoors most of his life.This patient's ear will be closely monitored for any signs of recurrence,which can be promptly treated by re-excision or radiation. Regular skin examinationsand sunscreen use were strongly recommended.(Case and photograph courtesy of Dr Robert P. Blereau.)