A woman in her 70s, came to our dermatology clinic with a painful sore on the outer rim of her left ear that had been present for several years. She admitted she almost always slept on her left side. Because the lesion would not heal and remained painful, she was understandably concerned about the possibility of skin cancer. On examination, we found a small, firm, tender nodule with a central crust on the helix of the left ear. The clinical findings were classic for chondrodermatitis nodularis helicis (CNH), a benign but often painful condition caused by chronic pressure on the ear.
Chondrodermatitis nodularis helicis is a benign inflammatory condition affecting the cartilage and overlying skin of the outer ear. It most commonly develops on the helix in older adults and is frequently associated with repeated pressure, such as sleeping on the same side every night, hearing aids, helmets, or other sources of chronic friction. Prolonged pressure is thought to contribute to damage to cartilage that presents as a painful nodule.
Although CNH is not cancerous, it can closely resemble skin cancers such as basal cell carcinoma or squamous cell carcinoma. Evaluation by a board-certified dermatologist is important to establish the correct diagnosis and determine whether a biopsy is necessary.
In our patient’s case, her habit of sleeping predominantly on her left side likely contributed to the development of the lesion. We discussed ways to reduce pressure on the affected ear during sleep like using a donut pillow and reviewed treatment options to relieve pain and promote healing.
This case highlights an important reminder that not every persistent sore on the ear is skin cancer. However, because painful ear lesions can closely resemble malignant growths, prompt evaluation by a board-certified dermatologist is essential for an accurate diagnosis and appropriate treatment.
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