Squamous cell carcinoma of the pinna: a 6-year study

doi:10.1016/0007-1226(94)90163-5

British Journal of Plastic Surgery

Volume 47, Issue 2, 1994, Pages 81-85

https://doi.org/10.1016/0007-1226(94)90163-5 Get rights and content

Abstract

Over a 6-year period, 54 sequential lesions of squamous cell carcinoma of the pinna were studied in 44 patients with regard to the side, clinical features and their duration, TNM clinicopathological classification, treatment and follow-up. Treatment delay, types of surgical procedures, anaesthesia and postoperative complications were all analysed. The overall incidence of residual and recurrent cancer was 25.92%. The regional lymph node recurrence was 9.26%, though only 5.56% had clinically persistent cancer. Six patients subsequently died; two of these deaths were due to the cancer.

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Cited by (29)

Our experience and modification of the Antia–Buch flap for pinna reconstruction
2023, Journal of Plastic, Reconstructive and Aesthetic Surgery
The Antia–Buch flap technique is used for the reconstruction of pinna helical defects. We present our modification of this flap to reconstruct large defects (greater than 20 mm) with good outcomes.
A retrospective review was conducted on all modified Antia–Buch flaps performed in a single unit from January 2011 to April 2019. All adult patients (greater than 16 years of age) who underwent this method of reconstruction after surgical excision of a pinna lesion were included. Measurements of the excision specimens from the final histological reports were used to determine the defect size. The helical lengths of the defect were used for analysis. Medical records were reviewed to identify postoperative complications from the reconstruction.
A total of 103 patients underwent the modified Antia–Buch flap reconstruction. All cases were performed by a single surgeon (senior author SA). Patients were 51–96 years of age (mean 76 years, SD±8.6), including 92 males and 11 females. The helical length of defects closed was between 12 and 42 mm (mean 26.7 mm, SD±6.46), and defect widths were 6–37 mm (average 14.5 mm, SD±5.28). There were 5 complications in our series (4.8% complication rate), with a revision rate of 2.9% (n = 3).
Our case series is the largest in the literature. Our modification demonstrates that large pinna defects can be reliably repaired with modification of the Antia–Buch flap that gives patients the option of a single-stage reconstruction without added morbidity and a good cosmetic outcomes.
Squamous cell carcinoma of the external ear: 170 cases treated with Mohs surgery
2021, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
SCC-E accounted for 11.2% (283/2522) of all HN cSCCs in our series, and the helix was the most common subsite with 45.3% of the tumours. This has also been reported by several authors, with incidences ranging between 32.9% and 57.2%.3,4,8,13,18,19 BCC and SCC represent between 94% and 100% of the tumours of the pinna.3,17,18,20
Squamous cell carcinoma of the ear (SCC-E) shows high rates of local recurrence (LR) and lymph node metastases (NM). SCC-E is the leading cause of death from nonmelanoma skin cancer.
To determine the LR and NM rates and survival after Mohs micrographic surgery (MMS).
We treated 170 invasive SCC-E with MMS with a mean follow up of 48 months. Mean age was 76 years, 93.2% were male patients, mean size: 1.5 cm, and 61.8% of the tumours were well differentiated.
We observed 5 LRs, 2 locoregional recurrences, and 16 NMs in 23 patients. LR and NM rates were 4.1% and 10.6%, respectively. Only 3/25 recurrences occurred after 2 years of follow up. We observed 1(0.6%) distant metastasis (DM) in a patient who also presented LR + NM. Six out of seven cases with LR and 8/18 with NM died of disease, regardless of aggressive surgical rescue with or without adjuvant radiotherapy. Five-year overall survival, disease-free survival, and disease-specific survival were 81%, 82.6%, and 89.7%, respectively.
Undeniably, the outcome in SCC-E is determined by locoregional control. DM are sporadic and rarely the cause of death. Systematic reviews and retrospective studies show a solid trend in favor of MMS vs surgical excision. The LR rate of this series (4.1%) is one of the lowest published to date with regard to SCC-E, and confirms this assertion.
We observed 10.6% NMs according to other series that treated the whole spectrum of SCC-E. Almost 2/3 of patients with NMs die after therapeutic rescue. We believe that it is essential to identify prognostic factors to select patients for one of the following: close surveillance (ultrasonography) during the first 2 years after surgery, sentinel node biopsy, or elective treatment of the nodes (surgery or radiotherapy).
Ear: External, Middle, and Temporal Bone
2020, Gnepp's Diagnostic Surgical Pathology of the Head and Neck, Third Edition
Lesions of the ear reflect the composition and environmental exposures of the ear’s constituent parts: the skin, subcutaneous tissues, and cartilage of the external ear; the mucosa, ossicles and bone, nerves, muscles, and blood vessels of the middle ear and mastoid; and the specialized epithelium and nerves of the inner ear, which, encased within the temporal bone, transmute sound and position sensation to electrical impulses and produce and regulate the flow of endolymph. Lesions of the external ear are predominantly lumps and bumps of skin and cartilage origin in elderly individuals. Middle ear lesions present with hearing loss, and, with an otoscope, a mass can be seen behind the normal or bulging eardrum. Lesions of the inner ear, located within the temporal bone, had been relatively inaccessible to biopsy, but with current imaging techniques, fine-needle aspiration biopsy, endoscopes, and recently developed base of the skull neuro-otologic techniques, no part of the ear is unreachable by skilled operators. Inner ear tumors are predominantly nerve sheath tumors, meningiomas, and rare lipomatous tumors of the eighth cranial nerve involving the internal auditory meatus. The papillary tumor of the endolymphatic sac, associated with von Hippel-Lindau disease, remains a rare and controversial lesion. Secondary tumors in the ear/temporal bone are invariably late manifestations of previously diagnosed tumors, either as metastases or direct local invasion.
Prediction score for lymph node metastasis from cutaneous squamous cell carcinoma of the external ear
2015, European Journal of Surgical Oncology
Citation Excerpt :
This study was not conducted to assess the anatomical localization of LNM in ear cancer. The clinician should be aware that the pattern of lymph drainage is quite variable, as described previously.7,12,29,31,32 Of outmost importance are the lymph nodes of the pre-auricular and parotideal region, the retro- and infra-auricular lymph nodes, and the cervical lymph nodes (mainly levels II to V according to Robbins et al.33).12,20,25
The frequency of lymph node metastasis (LNM) is higher in cutaneous squamous cell carcinoma (cSCC) of the ear than in other head and neck cSCCs. Nodal dissemination is associated with a significantly worse prognosis and disease-specific survival. The aim of this study was to establish a prediction model for LNM in patients with cSCC of the ear.
Tumour characteristics of 353 patients with ear cSCC were analysed to assess differences between those with and without LNM and to calculate a prediction score for LNM occurrence.
Regional LNM occurred in 10.5% of patients. Five-year disease-specific survival was significantly lower in the LNM group than in the control group (59% vs. 99%; p < 0.001). Recurrence number, invasion of cartilage, tumour depth, and tumour grading were the most important predictors for LNM, with correct prediction of LNM in 94.0% of cases. Our prediction score stratified patients into high and low risk groups (p < 0.001) with a sensitivity of 89.2%, a specificity of 94.6%, and an overall accuracy of 94.1%.
Our new prediction model was able to accurately identify patients at high risk of LNM who may benefit from elective lymph node surgery.
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2009, Diagnostic Surgical Pathology of the Head and Neck: Expert Consult - Online and Print
Ear: External, Middle, and Temporal Bone
2009, Diagnostic Surgical Pathology of the Head and Neck

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¹: Formerly SHO at Manor and George Eliet Hospitals. Nuneaton.

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Squamous cell carcinoma of the pinna: a 6-year study

Abstract

Br J Plast Surg

Am J Surg

Clin Plast Surg

Manual for staging of cancer

Carcinoma of the external ear

Scand J Plast Reconstr Surg

Cancer of the ear: a report of 150 cases

Laryngoscope

Auricular malignant neoplasms: when is chemotherapy (Moh's technique) necessary?

Arch Otolaryngol

Neoplasms of the conchal bowl: treatment with Moh's micrographic surgery

J Dermatol Surg Oncol

Squamous cell carenoma of the external ear: a review of 75 cases

Otolaryngol Head and Neck Surg

Carcinoma of the ear: retrospective analysis of 61 patients

The Journal of Laryngology and Otology