Erythematous Protruding Skin Lesion in the Retroauricular Area: A Quiz

Abstract

A 31-year-old Korean man presented with an asymptomatic, easy-to-bleed, solitary, rapidly enlarging, and erythematous protruding skin lesion with a stalk on the posterior auricular area, which he had first noticed 6-7 weeks prior to visiting our clinic (Fig. 1). In June 2010, the patient had been diagnosed with chronic myelogenous leukaemia, which was treated first with hydroxyurea and, since September 2012, had been managed with oral radotinib, 600 mg/day. The patient had no history of trauma and denied any family history of similar skin lesions. Our initial impression was pyogenic granuloma or accessory tragus. A skin biopsy showed a proliferation of small-to-medium-sized blood vessels with a cobblestone appearance of enlarged endothelial cells that projected into the lumina. A perivascular inflammatory cell infiltrate was composed mainly of lymphocytes and eosinophils (Fig. 2). The lesion has not recurred during 1-year follow-up after excision and electrodessication. Fig. 2. Cobblestone appearance of enlarged endothelial cells that projected into the lumina, and perivascular inflammatory cell infiltrates composed mainly of lymphocytes and eosinophils (haematoxylin and eosin; × 400).