When asked, the patient usually admits to sleeping on the affected side. Removal of the crust often reveals a small channel. Color is similar to that of the surrounding skin, although a thin rim of erythema may exist. Size may range from 3-20 mm. The right ear is affected more commonly than the left, and bilateral distribution occurs occasionally.
Lesions develop on the most prominent projection of the ear.
The most common location is the apex of the helix. Distribution on the antihelix is more common in women. Sleeping on the affected side may be an important etiologic factor. Biopsy is indicated if the diagnosis is in doubt. Often biopsy is necessary to differentiate CNH from basal cell carcinoma or squamous cell carcinoma, since many patients with CNH have chronic solar damage and a history of skin cancer.