An 84-year-old man is seeing an audiologist for hearing problems when the medical assistant notices a lesion on the patient’s right ear. When asked about it, the patient acknowledges that it has been bothering him. It itches and won't heal, no matter how much "medicine" the patient applies. Fortunately, it is not painful. But the patient is greatly annoyed that the lesion sometimes bleeds, leaving spots on his pillowcase and clothing.
The audiologist requests a consultation by the dermatology PA at her clinic.
EXAMINATION
The patient is an elderly white man in a wheelchair who is able to communicate readily. He is adamant that the lesion has only been present for about two weeks. However, his wife, who is with him, is sure it has been there for more than a year.
The lesion is a 1.6-cm ulcer with a telangiectatic, rolled pearly border. It is located between the tragus and antitragus on the outer floor of the patient’s external auditory meatus. It is seen in the context of the patient’s very fair and sun-damaged skin, which is also marked by numerous actinic keratoses on his face.
Under local anesthesia, shave biopsy is performed. A 5-mm slice is removed from the periphery of the lesion.
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