Melanocytic nevus is a prevalent condition characterized by black lesions within the ear canal. The exceedingly rare occurrence and concealed location of melanoma in the ear canal often result in delayed presentation and diagnosis at more advanced stages. Therefore, clinicians must remain vigilant for other potential causes of pigmented lesions in the ear canal. In this report, we present the first documented case of an amorphous black material foreign body masquerading as a melanocytic nevus in the external auditory canal. We encountered a case involving a 41-year-old female who presented with complaints of right-sided otalgia and pruritus. Otoscopic examination revealed an irregular black lesion within the left external auditory canal. Intraoperative excision subsequently identified the lesion as an amorphous black pigment foreign body. Due to subtle erosion of the bony ear canal, both fascia and tragal cartilage were grafted after complete removal of the lesion. This case highlights the importance of considering foreign body granuloma of the ear canal, which may mimic a melanocytic nevus or melanoma.
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