<p>A 54 year old man presented with a sore in his ear, which had been present for at least 2 years. There was no other relevant skin history, with no ulcers elsewhere. The patient took no regular medication.</p><p>Examination revealed an ulcer. Dermoscopy added little. There was no lymphadenopathy. What is the differential?</p><p>Given the chronic history and lack of skin changes elsewhere I felt that malignancy was more likely than not. Both moderately-poorly differentiated SCC, and BCC can ulcerate so I proceeded to carry out an urgent punch biopsy. The diagnosis confirmed an infiltrative BCC. I have since referred the patient for the opinion of a Mohs surgeon.</p><p>Image copied with kind permission from South Tees Hospitals NHS Foundation Trust.<span></span><br></p>
