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Cutaneous granuloma fissuratum
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Cutaneous granuloma fissuratum

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Contributors: David O'Connell MD, Vimal Prajapati MD, Ben Barankin MD, Susan Burgin MD
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Synopsis

Cutaneous granuloma fissuratum : Plaque with ulcer, Post auricular scalp, Posterior aspect of ear, Skin erosion, Smooth nodule
Cutaneous granuloma fissuratum, also known as granuloma fissuratum and acanthoma fissuratum, is an uncommon skin lesion resulting from chronic low-grade trauma. It arises as a result of ill-fitting eyeglasses and classically involves one or both of the superior retroauricular areas where the bow of the frames rests on the area of the superior sulcus. It may alternatively involve the lateral bridge of the nose due to trauma from a nose pad.

Granuloma fissuratum manifests as a flesh-colored or pink papule or nodule of rubbery to firm consistency. Auricular lesions commonly exhibit a central furrow or groove corresponding to the area of contact with the glasses' frame.

Codes

ICD10CM:
L25.9 – Unspecified contact dermatitis, unspecified cause

SNOMEDCT:
27745000 – Granuloma fissuratum

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The main differential diagnosis for unilateral cases includes cutaneous malignancies. Benign lesions to be differentiated include keloid, seborrheic keratosis, and chondrodermatitis nodularis helicis.
  • Basal cell carcinomas (BCCs) are pearly with overlying telangiectasia. They tend to bleed easily with trauma.
  • Squamous cell carcinomas (SCCs) are more hyperkeratotic, often with central crusting rather than a grooved depression.
  • Keratoacanthoma typically presents as a solitary, hyperkeratotic, skin-colored or erythematous nodule with central keratotic core. It develops rapidly in contrast to the more indolent granuloma fissuratum.
  • Keloid can develop on the ear or periauricularly. Clinically, keloid is a firm, exophytic, smooth nodule in an area of previous trauma.
  • Seborrheic keratosis is not uncommon to auricular sulci, and irritation from eyeglass frames may predispose to it.
  • Chondrodermatitis nodularis helicis typically involves the helix or antihelix proper; it is a small, firm, and tender papule or nodule.
The terms granuloma fissuratum and acanthoma fissuratum have been applied to similar lesions of the mucosa, such as in the oral cavity and genital area. Oral granuloma fissuratum is also known as epulis fissuratum. A hyperplastic plaque develops at the site of chronic rubbing from dentures. Granuloma fissuratum of the vulva is the presence of recurrent or persistent fissuring at the posterior fourchette. It may be seen following trauma and underlying lichen sclerosus, atrophic vaginitis, or eczematous dermatitis may be present.

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Last Reviewed:05/11/2020
Last Updated:05/11/2020
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Cutaneous granuloma fissuratum
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Cutaneous granuloma fissuratum : Plaque with ulcer, Post auricular scalp, Posterior aspect of ear, Skin erosion, Smooth nodule
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