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Patient Story
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A 7-year-old boy comes into the office with his mother with complaint of a fleshy growth in front of his left ear (Figure 20-1). It has been present since birth. He passed his newborn hearing screen and the parents were told that it was nothing to worry about. Recently, other children have teased him about it and mom inquires about having it removed. He has no other congenital abnormalities evident to date and no chronic medical problems.

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FIGURE 20-1

A preauricular skin tag in a 7-year-old boy. (Used with permission from Richard P. Usatine, MD.)

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Introduction
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Preauricular tags are benign congenital abnormalities consisting of epithelial mounds or pedunculated skin located near the front of the ear that can be associated with other conditions.

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Epidemiology
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  • Occur in approximately 1 of 10,000 to 12,500 births without predilection for gender or race.

  • Ear malformations may occur in isolation or as part of a constellation of abnormalities, often involving the renal system. Children have a five-fold risk of hearing impairment (8 of 10,000 vs. 1.5 of 10,000).1

  • Postnatal hearing loss has not been associated with preauricular tags.2

  • Several chromosomal abnormalities include preauricular tags as one of the phenotypic expressions.

  • The Goldenhar syndrome includes preauricular skin tags, bilateral limbal dermoids of the eye and eyelid colobomas (see Chapter 34, Congenital Anomalies of the Head and Neck).

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Etiology and Pathophysiology
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  • Arise from remnants of supernumerary brachial hillocks.3

  • Early stage embryology involves the formation of several slit-like structures on the side of the head, the branchial clefts. The three hillocks between the first four clefts eventually form the structure of the outer ear. Preauricular tags are generally minor malformations arising from remnants of supernumerary branchial hillocks.4

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Diagnosis
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  • Based on physical examination.

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Clinical Features of Preauricular Tags
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  • Fleshy knob in front of the ear (Figures 20-1 to 20-5).

  • May be 2 tags on one side of similar or different sizes (Figures 20-2, 20-4, and 20-5).

  • Present from the time of birth.

  • Generally asymptomatic.

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FIGURE 20-2

Two preauricular tags in a young black girl. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 20-3

Preauricular tag in a 1-year-old boy. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 20-4

Two preauricular tags in a 4-year-old girl. (Used with permission from Richard P. Usatine, MD.)

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