A case of dysplastic nevus of the external auditory canal presenting with conductive hearing loss

A nevus which is a benign melanocytic neoplasm rarely occurs within the external auditory canal (EAC). A dysplastic nevus presents atypical features both clinically and histologically, and is important as a potential precursor for melanoma. We present a case of a 33-year-old female patient with a dysplastic nevus in her EAC. Physical examination revealed a protruding mass arising from the posterior wall of the left cartilaginous EAC. The mass showed clinically characteristic findings of a melanocytic nevus. The patient underwent excisional biopsy via a transcanal approach under local anesthesia. Histopathological examination revealed an intradermal nevus with atypical melanocytes without pleomorphism. There was no evidence of recurrence two years after surgical excision.

Pigmented nevus of the external auditory canal

OBJECTIVE

To present the clinical experience during an 18-year period of a series of 11 cases of pigmented nevus of the external auditory canal (EAC).

STUDY DESIGN AND SETTING

Retrospective medical review of 11 consecutive patients with lesions seen in 2 departments of otolaryngology in Taiwan.

RESULTS

12 pigmented nevi, 2 to 12 mm (average, 6.4 mm) in diameter, were excised under otomicroscopy, and the EAC was packed with a temporary Penrose stent. One large lesion developed a postobstructive external auditory canal cholesteatoma (EACC). Histopathologic examination revealed 11 intradermal nevi and 1 compound nevus. There have been no recurrences or stenoses of EACs after 3 months to 17 years (average, 6 years) of follow-up.

CONCLUSION

If a pigmented nevus causes symptoms, especially when it is large enough to obstruct the lumen of the EAC and has the possibility of developing into an EACC, it should be excised.

EBM RATING

C-4.

An intradermal nevus of the external auditory meatus

We herein describe a rare case of an intradermal nevus arising in the external auditory meatus. A 36-year-old woman presented with progressive hearing loss on the right ear, and otomicroscopic examination revealed the presence of a large, violaceous, dome-shaped, papillomatous lesion originating from the posterior wall of the external canal of the right ear. Upon excisional biopsy, the tumor was diagnosed as an intradermal nevus. Thus, this is a unique case of intradermal nevus obstructing the external ear canal with the patient presenting with progressive hearing loss. The possibility of a benign nevomelanocytic nevus should not be underestimated when evaluating a lesion obstructing the ear canal, and all melanocytic nevi should be excised instead of biopsied to rule out melanoma.