Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2024;14(4):e2024257 1 Multiple Accessory Tragus with Cervical Chondro-Cutaneous Branchial Remnant of the Neck Cristina Bertoli1, Caterina Longo1,2, Vito Di Lernia3 1 Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy 2 Department of Dermatology, Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy 3 Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Italy Citation: Bertoli C, Longo C, Di Lernia V. Multiple accessory tragus with cervical chondro-cutaneous branchial remnant of the neck. Dermatol Pract Concept. 2024;14(4):e2024257. DOI: https://doi.org/10.5826/dpc.1404a257 Accepted: May 15, 2024; Published: October 2024 Copyright: ©2024 Bertoli et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Cristina Bertoli, Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. E-mail: cribertoli16@gmail.com Case Presentation A 1-month-old female was referred because of multiple pre- auricular tags from birth. Physical examination revealed three skin-colored papules in the right preauricular region and another one, respectively, on the right and left cheek. Moreover, a small firm papule was noted on the right an- terior sternocleidomastoid line (Figure 1). Similar lesions were reported in the paternal grandmother. Ultrasound re- vealed an accumulation of solid hyperechoic tissue with a fibro- lipomatous appearance not linked to deep soft tissues in the face and neck. No additional anomalies were detected after a pediatric evaluation. Audiometric test was normal. A diagnosis of congenital multiple and bilateral accessory tragus (AT) associated with cervical chondro-cutaneous branchial remnant (CCBR) was made. According to the pa- rental decision, surgical excision was delayed. Teaching Point AT is a developmental defect caused by an incomplete fusion of the first and the second branchial arches during the fifth and sixth weeks of embryogenesis [1]. Commonly found in the preauricular region, AT may also occur anywhere along an imaginary line from the tragus to the mouth angle or the anterior border of the sternocleidomastoid muscle, leading to CCBR [1-2]. AT and CCBR are choristomas, consisting of skin, subcutaneous fat and/or cartilage. They present as a solitary papule/nodule at birth, though multiple lesions with family history are possible [1-2]. Differential diagnosis in- cludes benign lesions of different derivation. A low risk of hearing loss may be associated with AT. Multiple or bilateral AT may be linked to the autosomal recessive Goldenhar syn- drome (oculo-auriculo-vertebral spectrum) and autosomal- dominant forms of Townes-Brocks, Teacher-Collins, 2 Image Letter | Dermatol Pract Concept. 2024;14(4):e2024257 VACTERL, Wolf-Hirschron syndromes [1]. CCBR is rather less common and may be associated with several non- auditory abnormalities as well as complex syndromes [2]. References 1. Bahrani B, Khachemoune A. Review of accessory tragus with highlights of its associated syndromes. Int J Dermatol. 2014 Dec;53(12):1442-6. DOI: 10.1111/ijd.12369. Epub 2014 Sep 30. PMID: 25266223. 2. Begovic N, Simic R, Vlahovic A, Kravljanac D, Djuricic S, Mijovic T. Cervical chondrocutaneous branchial remnants– report of 17 cases. Int J Pediatr Otorhinolaryngol. 2014 Nov;78(11):1961-4. DOI: 10.1016/j.ijporl.2014.08.038. Epub 2014 Sep 1. PMID: 25234732. Figure 1. (A) Three tender papules on the right preauricular region, one of which occurs on an area of hypertrichosis, plus a larger pe- dunculated one on the right cheek. (B) A small firm papule on the anterior right sternocleidomastoid line.