A 66-year-old male presented with a right ear lesion that had been present for 6 months. The lesion had gradually increased in size, prompting medical evaluation. He denied any associated pain, discharge, bleeding, or constitutional symptoms. His past medical history and past surgical history were unremarkable. He reported a family history of a similar ear lesion. He was not taking any regular medications and had no known drug allergies. Local examination of the apex (superior helix) of the right pinna revealed a well-circumscribed, elevated, dome-shaped erythematous nodule measuring approximately 1.5 × 1.5 cm. The nodule displays a central crateriform ulceration containing a dense, whitish-yellow keratinaceous core/plug. The surrounding rolled margins are smooth, hyperemic, and elevated, with minimal serosanguinous exudate and focal brownish crusting visible along the base. The remainder of the auricular cartilage and helix appear intact, without generalized perichondritis or surrounding satellite papules.

Ultrasound demonstrated an irregular solid hypoechoic lesion involving the helix of the right external ear, measuring 27 × 12 × 9 mm. The lesion was markedly hypervascular and appeared to invade the underlying cartilage, making it highly suspicious for malignancy. A few bilateral cervical lymph nodes, predominantly on the right side, were identified. These were variable in size but remained well defined, with cortical thickness <3 mm, preserved oval morphology, and maintained echogenic hila, consistent with benign/reactive lymph nodes. The largest measured 25 × 6.5 mm in the right submandibular region and 4 × 2 mm in the right postauricular region. The thyroid gland was normal in size and echotexture, with no focal lesions. The bilateral parotid and submandibular glands were unremarkable.

Under general anesthesia and in the supine position, a small transverse incision was made over the left ear lobule lesion. Wide local excision (WLE) of the lesion was performed and the specimen was sent for histopathological examination. Meticulous hemostasis was achieved. No drain was required. The wound was closed in anatomical layers with approximation of the subcutaneous tissue followed by skin closure. The patient tolerated the procedure well and was transferred to the recovery unit in stable condition.

Histopathological examination of the right ear helix wide local excision specimen revealed basosquamous carcinoma (metatypical basal cell carcinoma) measuring 1.5 cm with a tumor thickness of 1.2 cm. The tumor invaded the subcutaneous fat but did not involve the underlying cartilage. Ulceration was present, while lymphovascular and perineural invasion were not identified.All surgical margins were negative, with the closest original deep (medial) margin measuring 0.9 cm, and the additional medial margin was free of tumor. Background solar elastosis was also noted.

The patient had an uneventful postoperative recovery following wide local excision of the right ear helix lesion. The surgical wound remained clean and well approximated, with satisfactory healing and no evidence of infection, hematoma, or wound dehiscence.