This 72-year old man developed an ulcer over his left helix. The biopsy was submitted to rule out squamous cell carcinoma. This is a typical presentation and clinical impression for chondrodermatitis nodularis helicis (CNH), as it shares many features with squamous cell carcinoma. The etiology of CNH is unknown, although some authors related it to trauma, perhaps from sleep or cell phone injury. The histology in this case is also classic, showing a benign ulcer with fibrinoid necrosis in the dermis. There is variable inflammation and granulation tissue. An "urban myth" circulates that this entity shows up on dermatology boards with the cartilage conspicuously absent, but this is not confirmed. The presence of cartilage is obviously helpful for the diagnosis, and transelimination of cartilage is a rare treat, but the diagnosis is often made from the characteristic epidermal and dermal alterations.
Histologic sections of skin show central flask-shaped epidermal ulceration with flanking acanthosis. Dysplastic changes are not seen. Helical cartilage is present in the dermis, ascending into the ulcer bed, with central fibrinoid necrosis. A fibrin rich ulcer bed is present, with associated vascular proliferation suggesting granulation tissue. A moderate inflammatory response is also present.