What’s hiding behind this ear?

The central area does look scarred but there is a raised area around the periphery of the lesion and this is where the punch biopsy should have been taken from. This is an infiltrating and sclerosing BCC. There are only strands of BCC between a thick collagen stroma and these strands can be missed with a small punch biopsy.

It is best to take several punch biopsies in the case that this diagnosis is suspected or an elliptical incisional biopsy across the edge. It will need wide excision and skin grafting to close the defect.