<p>A 78 year old man was referred with a possible BCC on the right ear. The lesion had been present for almost one year with no recent history of change. The lesion had not bled but it was painful when laid on in bed. </p>
<p>Clinically there was a small papule on the antihelix (blue arrow) with a central area of keratin.</p>
<p>What is the diagnosis? </p>
Dermoscopy - Introduction, Terminology and Structures
A document to help you understand the dermoscopic descriptions used in this blog.
Dermoscopy Algorithm
To help you work through dermoscopic cases.
<p>The diagnosis is that of chondrodermatitis nodularis helicis (CDNH), a painful but benign condition that affects the cartilaginous portion of the ear. CDNH is best regarded as a pressure sore, with pressure from sleeping on the affected ear impairing blood flow leading to tissue damage. </p>
<p>The history of a lesion affecting one of the pressure points of the helix or antihelix, and causing pain at night are important clues to the diagnosis. The lack of significant growth points away from a squamous cell carcinoma. </p>
<p>While dermoscopy does not clinch the diagnosis of CDNH it can be helpful in excluding other conditions such as BCC. In this case the lesion had a central area of keratin (blue arrow), a common finding in CDNH, and lacked arborising vessels or anything else untoward.</p>
<p>For more information on CDNH please refer to the <a href="http://www.pcds.org.uk/clinical-guidance/chondermatitis-nodularis-helicis">relevant chapter</a> of the PCDS website. </p><p><br>Images property of South Tees NHS Foundation Trust.<span></span><br></p>
