The parents of a 4-year-old girl present to request removal of skin lesions adjacent to their daughter’s right ear. The growths have been present since birth and are enlarging in size. Developmental milestones are reported as normal and the child is in good health. Examination reveals flesh-colored, nontender projections of the right preauricular area. No similar lesions are noted elsewhere.
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Accessory tragus is a malformation of the external ear that usually presents at birth. The condition occurs in less than 0.5% of live births and the prevalence is similar in boys and girls.1 Lesions may be sessile or pedunculated and the majority are located within the preauricular area.
Most cases arise in the absence of underlying conditions although some may be associated with branchial arch syndrome, cleft palate, and mandibular hypoplasia.2 Goldenhar syndrome (oculo-auriculo-vertebral dysplasia) is a rare congenital disorder associated with ocular disease, hearing loss, scoliosis, and preauricular tragi.3 Multiple lesions may also be associated with Down syndrome.4
Diagnosis is usually made clinically. Histology reveals numerous miniature mature hair follicles and prominent connective tissue with or without a cartilaginous component.5 Lesions have no malignant potential. Surgical excision is curative in cases with cosmetic concerns.
Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
1. Solak SS, Altunay IK, Demirci GT, Can B. Prevalence of congenital cutaneous anomalies in 1000 newborns and a review of the literature. Am J Perinatol. 2015;33(1):79-83. doi:10.1055/s-0035-1556884
2. Mehmi M, Balasubramaniam P, Bhat J. Accessory tragus—beware of the preauricular “skin tag”. J Am Acad Dermatol. 2007;56(2):AB54.
3. Schmitzer S, Burcel M, Dăscălescu D, Popteanu IC. Goldenhar Syndrome— ophthalmologist’s perspective. Rom J Ophthalmol. 2018;62(2):96-104.
4. Verma P. Multiple accessory tragi in a case of Down’s syndrome. Indian J Dermatol Venereol Leprol. 2012;78(6):776. doi:10.4103/0378-6323.102401
5. Satoh T, Tokura Y, Katsumata M, Sonoda T, Takigawa M. Histological diagnostic criteria for accessory tragi. J Cutan Pathol. 1990;17(4):206-210. doi:10.1111/j.1600-0560.1990.tb00086.x