Many spesific chronic infections which cause granulomatous lesions, non-infectious systemic granulomatous diseases, idiopathic cutaneous granulomas and some diseases in which granulomas occur as a reaction to the exogenous factors may involve the ears. The granulomatous lesions of lupus vulgaris have a predilection for earlobes, but can be observed on any part of the ear (Figs. 16.1, 16.2). They can be strictly limited to the ear in some cases. M. tuberculosis is thought to reach the ear by haematogenous spread. Reddish brown, soft nodules and plaques tend to be asymptomatic and grow slowly. Neglected or misdiagnosed lesions may enlarge forming huge tumors and cover most of the ear surface (Figs. 16.3, 16.4). Deep infiltration may cause destruction of the ear cartilage (lupus vulgaris mutilans). Treatment with multidrug regimens for tuberculosis is effective against the chronic lesions. However, the earlobe lesions may heal with atrophy and result in disfigurement. Swimming pool granuloma is an atypical mycobacterial infection starting at the site of injury due to the inoculation of Mycobacterium marinum. Purple red papulonodular lesions may sometimes be located on the nose and ears as these sites are subjected to physical trauma.