SummaryA 21 year old man complained of pain and burning sensation on the helices of both ears, precipitated by cold weather. Examination showed tender erythematous nodules. Biopsies of both ears showed the characteristic vascular and inflammatory changes of pernio. In addition, in the left ear, there were foci of necrotic collagen surrounded by palisaded histiocytes. The presence of necrobiosis in pernio has not been reported previously. In this case, necrobiosis would appear to have a vascular basis.