The accessory tragus is thought to arise from a embryological defect involving the branchial arch. It is often present in a pre-auricular location, as in this case, but may appear along the path to the corner of the mouth, or more rarely, over the sternocleidomastoid muscle. When in the latter location, some authors use the unflattering term "wattle". This lesion may be confused with a fibroepithelial polyp (acrochordon) or soft fibroma, but the anatomic location and the presence of vellus follicles and cartilage leads to the correct designation.
Histologic sections of skin show a polypoid structure containing skin, hair, fibroadipose tissue and cartilage. It is otherwise unremarkable.