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56-Year-Old with a Sudden Enlarging Tumor on his Ear

Can you diagnose this case?

David L. Kaplan – 2014 Series Editor University of Missouri: Kansas City, University of Kansas

Signs and Symptoms

A 56-year-old male presented with a sudden enlarging tumor on his ear of less than 1 month duration. There is no previous trauma. He is not immunocompromised.

What could be responsible for the tumor?

Choose one to reveal diagnosis and discussion

Squamous cell carcinoma
Basal cell carcinoma
Amelanotic melanoma
Atypical fibroxanthoma
Merkel cell tumor

 Atypical fibroxanthoma 

See the full case at Consultant360

Atypical fibroxanthoma is a rare tumor of fibrocytic or myofibrocytic differentiation. The histologic picture is very ominous appearing with atypical multinucleated giant cells and mitoses often being seen. The characteristics can include aggressive behavior, including involvement of larger portions of the subcutis or deep soft tissues, vascular or perineural invasion, and the presence of necroses. Reports of involvement of lymph nodes are present in the literature. Fortunately, these lesions typically do well with simple excision with margins though most dermatologists believe frozen section analysis at the time of excision using Mohs surgery is beneficial to ensure clear margins. Close coordination of care with primary care providers to monitor extracutaneous involvement is advised.