Inverted follicular keratosis of the ear lobe masquerading as malignancy

Inverted follicular keratosis (IFK) is a rare benign tumour of the hair follicle infundibulum, often misdiagnosed as malignancy due to its clinical resemblance to squamous cell carcinoma and basal cell carcinoma. It typically presents as a solitary lesion on the face or neck of elderly individuals. Involvement of ear lobes is a rare occurrence. We report a case of a 66-year-old male who presented with a painful, progressively enlarging nodule on the posterior aspect of the left ear lobe. The lesion was clinically suspected to be squamous cell carcinoma or chondrodermatitis nodularis helicis. Histopathological examination following a punch biopsy confirmed the diagnosis of IFK. The patient was referred for surgical excision, which remains the mainstay of treatment. This case highlights the diagnostic challenge posed by IFK and underscores the importance of histopathology in distinguishing it from malignancies.