Clinical Features of the Black Hairy Mole on the Left Ear Tragus
Location & Morphology
- The lesion is situated on the tragus of the left ear, a cartilaginous prominence at the anterior margin of the external ear canal.
- It is a raised, dome‑shaped mole with a black pigmentation.
- The surface is covered with coarse terminal hairs
Size & Duration
- The mole is large and longstanding, with a history of gradual growth over decades.
- Its size and prominence make it cosmetically noticeable.
Surface & Consistency
- The surface appears smooth with hair growth.
- The lesion is firm, consistent with a benign melanocytic nevus.
Clinical Behavior
- No ulceration, bleeding, or rapid enlargement noted, supporting a benign nature.
- The slow growth pattern and absence of malignant features (such as irregular borders, color variegation, or nodularity) are reassuring.
Associated Risks
- Anatomical challenge: The tragus has thin skin with little subcutaneous tissue, lying directly over cartilage.
- Functional risk: Its proximity to the external ear canal means that any excision or laser ablation must avoid damage to the ear canal lining or tympanic membrane.
- Healing considerations: High tension and limited circulation in this area increase the risk of delayed healing, infection, or scar contracture.
Cosmetic Impact
- Due to its dark pigmentation, raised contour, and hair growth, the mole is conspicuous and aesthetically undesirable.
- Patients often seek removal for cosmetic improvement and relief from self‑consciousness.
Clinical Report of CO₂ Laser Excision of a Mole on the Ear Tragus
Introduction
The tragus of the ear is a challenging anatomical site for mole removal due to its thin skin, limited subcutaneous tissue, and proximity to the external ear canal. A black hairy mole in this location not only poses cosmetic concerns but also requires meticulous surgical technique to avoid functional complications.
Procedure
The mole was excised using a CO₂ laser, which offers precise tissue vaporization and excellent hemostasis. The laser ablated the lesion layer by layer, ensuring that the root was completely removed to prevent recurrence. Given the depth of the defect and the high tension in this area, primary closure with sutures was necessary. Fine sutures were placed to approximate wound edges, reduce infection risk, and minimize scar contracture.
Postoperative Course
- Suture removal: Sutures were removed at 2.5 weeks post‑operation, allowing sufficient time for wound stabilization in this high‑tension region.
- Healing: The wound initially showed mild erythema and depression, but over the following months, the scar gradually faded.
- Outcome: At 5 months post‑operation, the scar was almost invisible to the naked eye, blending seamlessly with surrounding tissue.
Discussion
CO₂ laser excision combined with suturing offers several advantages over traditional scalpel excision:
- Precision: The laser allows controlled ablation, minimizing collateral damage.
- Hemostasis: Thermal coagulation reduces intraoperative bleeding.
- Cosmetic result: With careful depth control and suturing, scarring is minimized even in high‑tension areas.
However, this approach demands significant expertise. The surgeon must balance complete lesion removal with preservation of surrounding structures, and postoperative care must be meticulous to prevent infection, especially given the tragus’s limited circulation and exposure to sweat, sebum, and water.
Conclusion
This case demonstrates that CO₂ laser excision with suturing can achieve excellent cosmetic and functional outcomes in mole removal from the ear tragus. Despite the anatomical challenges, the combination of advanced laser technology and precise surgical closure resulted in a nearly invisible scar at 5 months, underscoring the value of integrating modern techniques with fundamental surgical principles.
臨床特徵：左耳耳屏上的黑色多毛痣
位置與形態
- 病灶位於左耳耳屏（外耳道前方的軟骨突起）。
- 為一顆隆起、圓頂狀的黑色痣。
- 表面長有粗硬的終毛。
大小與病程
- 病灶較大，存在多年，呈緩慢生長。
- 因位置顯眼，美容影響明顯。
表面與質地
- 表面平滑且有毛髮生長。
- 質地堅實，符合良性黑色素痣的特徵。
臨床行為
- 無潰瘍、無出血、無快速增大，支持其良性本質。
- 生長緩慢，邊界規整，顏色均勻，無惡性徵象。
相關風險
- 解剖挑戰：耳屏皮膚薄，皮下組織少，直接覆蓋軟骨。
- 功能風險：鄰近外耳道，若切除或雷射處理不慎，可能損傷耳道黏膜或鼓膜。
- 癒合考量：此區域張力大、血液循環差，增加延遲癒合、感染或疤痕攣縮的風險。
美容影響
- 由於顏色深、隆起且伴隨毛髮，痣十分顯眼，影響外觀。
- 患者常因美容原因要求去除。
醫療報告：耳屏痣的 CO₂ 雷射切除與縫合
引言
耳屏是耳部痣切除的高難度解剖區域，因為皮膚薄、皮下組織少，且鄰近外耳道。位於此處的黑色多毛痣不僅影響外觀，亦需精細的手術技術以避免功能性併發症。
手術過程
本病例採用 CO₂ 雷射進行切除。雷射能精準汽化組織並提供良好的止血效果。手術中逐層汽化病灶，確保 連同根部完全去除，以防復發。由於缺損較深且耳屏張力高，術後需進行 一期縫合。使用細緻縫線將傷口邊緣對合，以降低感染風險並減少疤痕攣縮。
術後過程
- 拆線：術後 2.5 週拆線，確保傷口在高張力區域已充分穩定。
- 癒合：初期傷口呈輕度紅斑與凹陷，但隨時間逐漸淡化。
- 結果：術後 5 個月，疤痕幾乎肉眼不可見，與周圍組織自然融合。
討論
CO₂ 雷射切除合併縫合相較於傳統手術切除有多項優勢：
- 精準度：雷射能精細控制深度，減少周邊組織損傷。
- 止血效果：雷射的熱凝固作用使術中出血極少。
- 美容效果：若深度控制得當並縫合精細，即使在高張力區域也能獲得平整疤痕。
然而，此技術對術者要求極高。醫師必須在徹底去除病灶與保護周邊結構之間取得平衡，並在術後提供嚴謹護理，以避免感染與延遲癒合。
結論
本病例顯示，CO₂ 雷射切除合併縫合能在耳屏痣去除中達到優異的美容與功能性結果。雖然該區域解剖挑戰大，但透過先進雷射技術與精細外科縫合，術後 5 個月疤痕幾乎不可見，充分展現了現代皮膚外科「雷射結合外科」的價值。