Perichondrium-Sparing Excision and Mastoid Subdermal Undermining for a Decade-Long Giant Retroauricular Verruca Vulgaris Mimicking Verrucous Carcinoma: An Observational Analytic Case Study

Abstract

Background: Cutaneous verruca vulgaris caused by human papillomavirus (HPV) rarely affects the external ear or exceeds 2.00 cm. Giant auricular lesions can resemble verrucous carcinoma (Ackerman's tumor) and cutaneous squamous cell carcinoma, complicating diagnosis and reconstruction.

Objective: To describe the diagnosis, surgical management, and six-month outcome of a decade-long giant retroauricular verruca vulgaris.

Methods: This study describes a 36-year-old immunocompetent man treated at Tidar Regional General Hospital and PKU Temanggung Hospital, Indonesia. Lesion history, caliper morphometry, perichondrial shear mobility, histomorphometry, closure tension, scar scales, and the auriculocephalic angle were recorded from the preoperative visit (T₀) to month 6 (T₅).

Results: Over 10 years, the sessile mass enlarged from a 0.20-cm papule to 3.30 × 1.50 × 1.00 cm (base area 3.89 cm²; volume 2.59 cm³) while remaining mobile over the perichondrium (≥3.0 mm). Elliptical excision with a 1.5-mm margin above the intact perichondrium left a 4.00 × 1.80 cm defect (5.65 cm²); 2.50 cm of subdermal undermining toward the mastoid and neck reduced closure tension from 3.80 N to 0.45 N (−88.2%). Histopathology confirmed verruca vulgaris (epidermis 2.85 mm [35.6× normal]; stratum corneum 1.15 mm [57.5× normal]; koilocytosis index 38.5%) with an intact basement membrane and no dermal invasion. At month 6, there was no recurrence, the Vancouver Scar Scale score was 0/13, and the auriculocephalic angle was symmetric (21.8° vs. 22.0°).

Conclusion: In this patient, in toto perichondrium-sparing excision allowed verrucous carcinoma to be excluded histologically, and extensive mastoid subdermal undermining permitted tension-free primary closure without auricular distortion.