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Mixed diagnoses – 10 cases (11 of 11)

For each of the ten cases, study the image and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately five minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.


Case 9

A 60-year-old horticulturist complains of a painful papule on his ear, which prevents him sleeping on the affected side.

Chondrodermatitis nodularis helicis chronicum et dolorum (CNH)

Basal cell carcinoma, squamous cell carcinoma, gouty tophus, chilblain, perichondritis, polychondritis, elastotic nodules

The treatment of choice is excision. Pressure on the affected area must be avoided long term. The patient should sleep on the unaffected side, or use a pillow with a hole cut in it for the ear. Recurrence of CNH is common following minor trauma eg: sleeping on the ear. Intralesional steroid injection may help early lesions.

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