Gout is the most common cause of inflammatory arthritis in men over 40 [1]. The prevalence of gout in the US is approximately 3.9%. Tophus is a characteristic sign of gout and results when monosodium urate deposits at the joint, skin, or cartilage. Tophi develop in 12-35% of patients who are diagnosed with gout [2]. We report a case of a 70-year-old man who was diagnosed with squamous cell carcinoma of the helix via shave biopsy. During Mohs micrographic surgery, a vigorous foreign-body reaction was noted. Review of the initial biopsy slides identified crystals with pseudoepitheliomatous hyperplasia (PEH) rendering a diagnosis of gout. This case emphasizes the importance of recognizing causes of PEH and the predilection for tophi to form on the ear.

Lichen planus is an inflammatory process that can affect the skin, mucosa, and hair follicles. An increased risk of squamous cell carcinoma has been noted in lichen planus of the mucosa. Rarely, in chronic, hypertrophic lichen planus of the skin, squamous cell neoplasms have been reported. We report a case of new onset lichen planopilaris with multiple squamous cell neoplasms.