Chondrodermatitis Nodularis Helicis

A 58-year-old female’s right ear shows a 0.5 cm diameter skin-colored nodular lesion with a central dry white top on the antitragus. She had noticed the lesion 1 month prior. It was asymptomatic. 

The lesion, along with some underlying ear cartilage, was excised in the office under local anesthesia with elliptical incisions and with undermining of adjacent skin edges to close the area primarily with 5-0 silk interrupted sutures. There was a characteristic “crunchy” sensation felt with the knife cutting at the lesion’s base. The lesion was removed incising the cartilage just below the “crunchy” feeling. 

The pathology diagnosis was chondrodermatitis nodularis helicis. 

Chondrodermatitis nodularis helicis is a chronic, benign, usually solitary, crusting painful lesion about 0.5 cm in diameter, usually occurring on the upper helix in males over 50 years old. In females it is much less common and usually on the antihelix. It is more common in fair-skinned and sun-damaged skin. 

Today the lesions are more common are believed due to increased use of cell phones occurring at the pressure point of the phone. Etiology is believed to be due to degeneration of dermal collagen with subsequent extravasation through the overlying skin. Contributing factors may include minor trauma, such as pressure from sleeping on the ear, poor vascularity, and solar damage.¹

Differential diagnosis includes nodular ulcerated basal cell carcinoma, squamous cell carcinoma, actinic keratosis, atypical fixoxanthoma, cystic chondromalacia, elastotic nodules of the ear, keratoacanthoma, Merkel cell carcinoma, and pseudocyst of the auricle. It may occasionally be associated with autoimmune disease, including autoimmune thyroiditis, lupus erythematosus, dermatomyositis, and systemic sclerosis —this is more common in pediatrics, adolescents, and young females .²

Treatments include wedge excision, curettage, electrodessication, and laser ablation. Excision of the nodule with underlying cartilage with primary closure gives excellent cosmetic results with low rate of recurrence. ■

Reference

1.Weedon D. Skin Pathology. 2nd ed. Churchill Livingstone. 2002; 364.

2.Marks V, Akins RS, Papa CA. Chondrodermatitis nodularis helicis. Medscape. Available at: http://emedicine.medscape.com/article/1119141-overview. Accessed May 2012.