We report a case of tophaceous gout occurring in a Hispanic 69-year-old immunocompetent man. The patient presented with a 0.8 cm pink, purple, and brown dome-shaped papule on the right superior helix of the ear. The lesion was tender to palpitation. A deep shave biopsy was performed and the histological findings demonstrated pseudoepitheliomatous hyperplasia overlying large dermal deposits of pink, hyalinized feathery material surrounded by mild granulomatous inflammation. This finding supported the diagnosis of tophaceous gout rather than the clinical findings imitating squamous cell carcinoma. Concurrently, the patient received an intralesional Kenalog (ILK) injection to suppress any existing or ensuing inflammation. Treatment of the residual lesion was achieved via curettage and electrodesiccation.
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