The diagnosis of rare skin lesions in ear, nose, and throat: the clues lie in clinical examination

Abstract

Here we present 2 case reports of 2 relatively rare skin lesion that can be encountered in ENT practice, and touch upon the basic clinical evaluation that is mostly overlooked in favour of investigations to reach a diagnosis, since in many cases, investigations fail to give a clear result. The first case is a pilomatricoma, which can be tricky differential diagnosis to reach in the preoperative phase, with the lesion not having any clear differentiating characteristics on imaging. But the answer to a preoperative diagnosis might lie in the “Tent Sign”, bluish discoloration of the skin, or calcium extrusion from the lesion. The second case is a keratoacanthoma, which, waiting long enough should regress on its own. But as watchful waiting is not a feasible line of management, the distinct crateriform pattern should be looked for in lesions on sun exposed areas, and if present, instead of just an incisional biopsy or wedge biopsy, complete surgical excision with clear margins and intact architecture should be planned.