Perforating pilomatricoma presenting as an ulcer in the helix of the pinna.

A 24-year-old woman presented with a painless swelling in her right pinna which was noticed about four months back and had a recent increase in size. On examination, a 1.5×1 cm, firm, non-tender skin-colored nodule was seen in the helix. A clinical diagnosis of keloid was rendered. Considering chances of recurrence following surgical excision and because the woman was not concerned about cosmesis, we preferred to wait-and-watch. We were skeptical about the provisional diagnosis though, as she gave no history of ear-prick, a custom common among women for wearing earrings, and also because there was a history of transient peri-lesional reddening one month back. She returned two weeks later with the swelling increased in size, erythematous, and covered by crust. The scab was removed and the raw, bleeding, necrotic surface exposed (Fig. 1). At this point, we considered some form of chronic granulomatous disease or pyogenic granuloma as alternative possibilities,