This patient has a keloid which is due to excessive collagen deposition.
Keloids are caused by excessive collagen deposition typically in response to trauma (ear piercings and burns are common inciting events). They are frequently found in young African-American patients, and can cause functional impairments (depending on location) as well significant cosmetic burden. Treatment is either with topical solutions or with surgical excision. However, surgical excision has a high rate of recurrence, and some practitioners have begun using cryotherapy as a method of excision.
Jucket and Hartman-Adams review the management of keloids. They note that keloids are often found in young patients with darker skin and are frequently found on the face and upper chest. Surgical removal of keloids is difficult due to high rates of recurrence, but that there are post-surgical treatments (such as pulsed dye laser or radiation) that may help reduce the rates of recurrence. There is little evidence that vitamin supplement is helpful in treating keloids.
Manca et al. conducted a case series of electrochemotherapy for keloids with bleomycin administered systemically as the "chemo" part of the therapy. They noted that the treatment was well-tolerated with no serious adverse effects, and a median reduction of 87% in volume size. Patients also had a reduction in pruritus, and there was only one recurrence at 18 months.
Figure A depicts a patient with an earlobe keloid.
Answer 1: Melanocyte proliferation is the precursor to melanoma development, not keloid development.
Answer 3: While fibroblasts are responsible for collagen deposition in keloids they are not neoplastic.
Answer 4: While keloids often form in response to trauma, they are not considered to be inflammatory lesions.
Answer 5: Given that this patient did not have this lesion prior to his attempted ear piercing it is very unlikely that this is a congenital malformation.
Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am Fam Physician. 2009 Aug 1;80(3):253-60. Review. PubMed PMID: 19621835.
PMID:19621835 (Link to Abstract)
Manca G, Pandolfi P, Gregorelli C, Cadossi M, de Terlizzi F. Treatment of keloids and hypertrophic scars with bleomycin and electroporation. Plast Reconstr Surg. 2013 Oct;132(4):621e-630e. doi: 10.1097/PRS.0b013e3182a053c8. PubMed PMID: 24076710
PMID:24076710 (Link to Abstract)