A mother brings in her 13-day-old baby for evaluation of facial lesions. Noted on examination are flesh-colored lesions located in front of both ears. No other facial or body lesions are visible. The baby was carried to term, and the pregnancy was uneventful for the mother.
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Accessory tragus is a congenital malformation of the external ear. The lesions can arise within the preauricular area to the corner of the mouth. The incidence of a single accessory tragus is 0.2% and 0.1% for bilateral lesions. Accessory tragi can accompany branchial arch syndromes, cleft palate, and mandibular hypoplasia.1 The most common syndrome associated with an accessory tragus is Goldenhar syndrome. Goldenhar syndrome is more common in males and typically involves the right side of the face. Characteristics seen with this syndrome are accessory tragus, mandibular hypoplasia, and ocular dermoids.2
Histology of an accessory tragus reveals miniature mature hair follicles and prominent connective tissue with or without a cartilaginous component.3 Surgical excision is the treatment of choice. If the accessory tragus is associated with an underlying syndrome, genetic testing and further evaluations are recommended.4
Rebecca Geiger, PA-C, is a physician assistant on staff at the DermDox Dermatology Center in Hazleton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
- Mehmi M, Balasubramaniam P, Bhat J. Accessory tragus—Beware of the preauricular “skin tag.” J Am Acad Dermatol. 2007;56(Suppl 2):AB54.
- Gaurkar SP, Gupta KD, Parmar KS, Shah BJ. Goldenhar syndrome: A report of 3 cases. Indian J Dermatol. 2013;58:244.
- Satoh T, Tokura Y, Katsumata M, Sonoda T, Takigawa M. Histological diagnostic criteria for accessory tragi. J Cutan Pathol. 1990;17:206-210.
- Bahrani B, Knachemoune A. Review of accessory tragus with highlights of its associated syndromes. Int J Dermatol. 2014;53:1442-1446.