Cutaneous Cyst
This cyst behind the ear used to be called a sebaceous cyst. It is a benign, closed, firm sac that lies in the dermis, forming a dome-shaped lump. It can be moved over underlying tissues but is attached to the epidermis. A dark dot (blackhead) may be visible on its surface. Histologically, one of two diagnoses is likely: (1) epidermoid cyst, which is common on the face and neck, and (2) pilar (trichilemmal) cyst, which is common in the scalp. Each may become inflamed.
The raised nodule behind this ear shows the lustrous surface and telangiectatic vessels that suggest basal cell carcinoma, a slow-growing and common malignancy that rarely metastasizes. Ulceration may occur, and in the absence of treatment extends in width and depth. Like squamous cell carcinoma, basal cell carcinoma occurs more frequently in fair-skinned people who have been much exposed to sunlight.
(Sources of photos: Chondrodermatitis Helicis, Cutaneous Cyst—Young EM Jr, Newcomer VD, Kligman AM: Geriatric Dermatology: Color Atlas and Practitioner's Guide. Philadelphia, Lea & Febiger, 1993; Squamous Cell Carcinoma, Basal Cell Carcinoma—Reprinted, by permission of the N Engl J Med, 326:169-170, 1992.)
Tophi |
Rheumatoid Nodules |
A tophus is a deposit of uric acid crystals |
In a patient with chronic arthritis, one |
characteristic of chronic tophaceous gout. |
or more small lumps on the helix or |
Tophi appear as hard nodules in the helix |
antihelix may be rheumatoid nodules of |
or antihelix and may discharge their |
rheumatoid arthritis, as shown here. Do |
chalky white crystals through the skin. |
not mistake such lumps for tophi. Look |
Tophi may also appear near the joints, as |
for additional nodules elsewhere, e.g., |
in the hands (p. 530), feet, and other |
on the hands, along the surface of the |
areas. Tophi usually develop only after |
ulna distal to the elbow (pp. 528, 529), |
years of sustained high blood levels of |
on the knees, and on the heels. |
uric acid. With better control of |
LTlceration may result from repeated |
hyperuricemia by drugs, tophi are |
small injuries. Rheumatoid nodules may |
becoming less common. |
antedate the arthritis. |
Keloid |
Lepromatous Leprosy |
A keloid is a firm, nodular, hypertrophic |
The ear is one of the sites for leproma |
mass of scar tissue that extends beyond |
tous leprosy, a form of Hansen's |
the area of injury. It may develop in any |
disease, which results from infection by |
scarred area, but is most common on the |
Mycobacterium leprae. The multiple |
shoulders and upper chest. A keloid on |
papules and nodules on this auricle are |
an earlobe that was pierced for earrings |
due to this chronic infection. Similar |
may be especially troublesome because |
lesions would probably be visible on |
of its cosmetic effects. Darker-skinned |
the face and elsewhere in the body. |
people are more likely than lighter ones |
Now seldom seen in the United States, |
to develop keloids. Recurrence of the |
leprosy is still a worldwide problem. |
growth may follow treatment. |
Other forms of the disease have |
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