This 94 year old retired primary care physician with macular degeneration, known to the practice for twelve years, was seen for an overdue periodic follow-up evaluation after an interval of two years. Binaurally aided with CLASS II (vented) canal hearing instruments, examination of the left pinna revealed a raw lesion of the superior antihelix (A). The site, originally identified as an actinic lesion, had been dermatologically treated with cautery five years earlier. The patient was referred back for dermatological consultation. A biopsy was taken with pathology report confirming a diagnosis of basal cell carcinoma. A course of radiation therapy was prescribed, as opposed to surgery, considering the patient's advanced years..

The patient was seen ten months later for a service visit on both hearing aids. Examination of the AS pinna revealed an exacerbation of the pathological condition noted earlier (B). The patient had declined to follow the dermatologist's prescriptive course of radiation therapy. An immediate referral was made back to the dermatologist who, in turn, reiterated the radiological referral.