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Slow-growing lesion behind the ear
Last reviewed: September 2023
Authors: Dr George Bethimoutis and Dr Vicky Akhras, Dermatologists, St Georges NHS, U.K. (2023)
Reviewing dermatologist: Dr Ian Coulson (2023).
Edited by the DermNet content department
Background
A 25-year-old male was referred to our skin cancer clinic with a one year history of an asymptomatic, slowly enlarging lesion in the right postauricular area. A biopsy showed focal hypergranulosis, basal cell liquefactive degeneration, and a dense upper dermal infiltrate of lymphocytes and melanophages.
What is the differential diagnosis?
What is the diagnosis?
Histology confirmed lichen planus follicularis tumidus, a very rare variant of lichen planus.
A full skin check is needed for other signs of cutaneous or mucosal lichen planus. The retro-auricular site is the location of predilection.
What are the treatment options?
Lichen planus follicularis tumidus is in essence a chronic-relapsing disease, and very resistant to treatment. Ultrapotent topical steroids, systemic steroids, and retinoids (topical or oral isotretinoin) have been suggested.
In the case of our patient, the lesion was surgically excised.