On examination, an 8-mm, red, telangiectatic, shiny exophytic lobulated papule was present on the helix of the right ear. A shave biopsy of the helical lesion was performed. Histologic analysis showed a nodular proliferation of atypical melanocytes with epithelioid morphology in a vertical growth pattern. The lesional cells showed markedly atypical to pleomorphic nuclei with occasional multinucleated forms, mitotic figures, and abundant cytoplasm. Immunohistochemical stains showed that the tumor cells were positive for S100, MART-1, and tyrosinase, supporting the diagnosis of melanoma. The atypical cells extended into the dermis consistent with malignant melanoma, nodular type, with at least Clark level IV invasion (Figure 2). The margins were involved, and the tumor thickness was at least 2.8 mm. There was also prominent papillary dermal edema with superficial dermal vascular and fibroblastic proliferation representing a possible angiofibroma in proximity to the tumor cells. He subsequently underwent reexcision of the lesion, and sentinel node biopsy findings were negative.