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November 2003
By Youn W. Park, MD, and Freeland G. Oliverio,
DO
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CASE:
A 10-year-old boy is brought in by his mother for possible
removal of a projection from his ear. The patient denies any
symptoms associated with this pointed lesion, located on the
edge of the helix of the auricle, which has been present since
infancy.
WHAT IS YOUR DIAGNOSIS?
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This patient has a Darwin's tubercle, a common lesion of the
ear that may remind one of Mr. Spock in Star Trek or
elves in cartoons. Usually located on the posterior edge of
the auricle at the junction of the upper and middle thirds of
the helix, it may be mistaken for a benign tumor, cartilage,
or calcification. It is homologous to the tip of the mammalian
ear. The tubercle is evident around the sixth month of fetal
development, and the whole auricle has a close resemblance to
that of some adult monkeys. Because of its phylogenetic interest,
this deformity of the pinna bears Darwin's name, even though
he was not the first to describe it. It remains asymptomatic
and is surgically removed only for cosmetic reasons, if at all.
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Dr. Park is a clinical professor of otolaryngology
at Northeastern Ohio Universities College of Medicine and
section head of otolaryngology at Barberton Citizens Hospital
in Barberton, Ohio. Dr. Oliverio is an attending physician
at Barberton Citizens Hospital.
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