One-Stage Earlobe-Based Transposition Flap After Full-Thickness Excision of a Congenital Verrucous Epidermal Naevus Spanning the Right Earlobe and Lateral Neck in a 3-Year-Old Boy: A Case Report With Dermoscopic and Histopathological Correlation

Abstract

Background: Verrucous epidermal naevus is a benign keratinocytic hamartoma that arises from post-zygotic somatic mutation and follows the lines of Blaschko. Lesions crossing the auricular and cervical units are uncommon and difficult to treat, because ablative and topical modalities clear the surface but leave the mutant keratinocyte clone.

Objective: To describe the diagnosis, reconstructive decision and outcome of a one-stage earlobe-based transposition flap after full-thickness excision of such a lesion in a preschool child.

Case Presentation: A 3-year-old boy was referred with a brown linear verrucous plaque measuring 7 × 0.75 × 0.1 cm, present on the right earlobe since birth and extending along the right lateral neck, thickening and becoming painful over three months. Dermoscopy showed cobblestone verrucous and papillomatous structures with brown to bluish-grey pigmentation and no melanocytic network. Absent pruritus and inflammation, and a normal systemic evaluation, excluded inflammatory linear verrucous epidermal naevus and epidermal naevus syndrome. Full-thickness excision under general anaesthesia with tumescent infiltration removed auricular and cervical specimens of 3.5 × 0.8 cm and 7 × 0.3 cm, and the defect was closed in one stage with an earlobe-based transposition flap. Histopathology showed hyperkeratosis, acanthosis and papillomatosis with focal hypergranulosis and vacuolated granular and spinous cells. Healing was uneventful; a hypertrophic scar confined to the cervical limb appeared by postoperative day 73.

Conclusion: Complete excision with a one-stage earlobe-based transposition flap achieved definitive clearance and preserved auricular contour. Suprabasal vacuolation in a keratinocytic naevus should prompt keratin gene sequencing and reproductive counselling.