Detailed case report of a solitary, painless conchal lesion in a 74-year-old patient. Features full pre- and postoperative histopathologic analysis, deep margin clearance (0.2 cm) without cartilage sacrifice, and recovery outcomes.
A 74-year-old female presented with a left ear skin lesion involving the conchal cartilage, characterized by skin changes without associated pain. Her past surgical history included a previous cesarean section and thyroid surgery, with no reported complications. She was on regular medication for hypertension and had no known drug allergies (NKDA). On inspection, there was a solitary, irregular, exophytic lesion involving the conchal region of the external ear. The lesion is erythematous with an irregular surface and areas of crusting/keratinous debris. There is focal dark pigmentation/discoloration over the lesion. The surrounding auricular skin appeared mildly erythematous.
Histopathology of the left ear skin lesion biopsy revealed basal cell carcinoma, micronodular type. The sections showed multiple fragments of ulcerated tissue containing variably sized infiltrative nests of basaloid cells with peripheral palisading and cleft formation. The tumor cells demonstrated scant eosinophilic cytoplasm, large pleomorphic hyperchromatic nuclei, and mitotic activity.
Under general anesthesia, the patient was placed in the supine position. A wide local excision of the left inner ear lesion was performed with excision of the involved skin lesion. Hemostasis was secured, and the wound was closed appropriately. No drain was inserted.
Histopathology of the left auricular concha wide local excision revealed a micronodular Basal cell carcinoma measuring 1.8 cm in greatest dimension and 0.5 cm in thickness. The tumor showed ulceration and extended into the subcutaneous fat, but there was no invasion of the underlying cartilage. No lymphovascular or perineural invasion was identified. The tumor was completely excised, with all resection margins free of tumor; the closest margin was the deep/posterior margin at 0.2 cm. The lateral, medial, inferior, and superior margins were clear by 0.8 cm, 0.7 cm, 1 cm, and 2.5 cm, respectively. The separate fibrofatty tissue fragments were negative for tumor.
The patient had an uncomplicated postoperative course following wide local excision of the left auricular conchal lesion under general anesthesia. The patient was followed postoperatively for wound healing and was advised to continue regular clinical surveillance for local recurrence or development of new skin lesions.
