Sebaceous Cyst Behind

Cutaneous Cyst Ear

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.

Basal Cell Carcinoma

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.)


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.


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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