Mary, a 92-year-old female, is reviewed by her GP at her nursing home with a two-week history of increasing burning right ear pain. At times, the pain is associated with the sensation of something moving inside her ear.

This occurs on a background of an enlarging skin lesion behind the ear, which is suspected to be SCC. This lesion pictured has been deemed inoperable, and, at the request of her next of kin, biopsy for histological confirmation has not been performed to avoid additional distress and discomfort. The lesion has been progressively enlarging and is now nearing the right external auditory meatus. Mary has experienced pain when lying on her right side and occasional gentle contact bleeding. The lesion is being managed palliatively with a protective dressing.