Differential diagnoses: Conditions affecting the ears

Dr Nigel Stollery explains the differences in characteristic features of diseases of the ear including nodular basal cell carcinoma, chondrodermatitis nodularis helicus, squamous cell carcinoma and haemangioma

Nodular basal cell carcinoma


  • Most common skin cancer, also known as rodent ulcer
  • Usually occurs in sun-exposed areas of the skin
  • Usually slow growing
  • Occurs initially as a papule, which then enlarges with central ulceration
  • Very low metastatic potential
  • If untreated, may destroy underlying cartilage


  • Surgical excision is the treatment of choice
  • If edges clearly defined, Mohs surgery can improve cure rates
  • In the elderly, radiotherapy may be an alternative option

Chondrodermatitis nodularis helicus


  • Painful inflamed nodule
  • Ranges in size from 3-20mm
  • Round or oval and appears adhered to underlying cartilage
  • Surface crusting may be present
  • Most common at apex of helix
  • Most probably due to pressure, cold and actinic damage
  • If in doubt, a biopsy can help


  • Treatment usually required
  • Avoid pressure, for example, use a pillow with a central hollow
  • Avoidance of sun exposure is important
  • Cryotherapy and surgery may be required
  • Recurrence rates after surgery of 10-30%

Squamous cell carcinoma


  • More aggressive type of skin malignancy than basal cell carcinoma
  • Occurs on sun-exposed areas, such as ears, hands and head
  • Potential for metastatic spread
  • May grow rapidly


  • Urgent referral for excision is required
  • Part of the two-week wait referral scheme
  • Future UV protection important



  • Vascular lesions with typical cherry red appearance
  • Benign lesions
  • Occur anywhere on the body
  • May bleed easily and profusely, especially after trauma


  • If diagnosis in doubt or symptomatic, excision advised
  • Histology important to exclude squamous cell carcinoma
  • Hyfrecation can be useful for multiple small lesions
  • Lasers are an alternative treatment option

  • Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary

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