Applicability of the Pittsburgh Staging System for Advanced Cutaneous Malignancy of the Temporal Bone

Abstract

The objectives are to evaluate the applicability of the Pittsburgh staging system (PSS) (designed for primary temporal bone malignancies) to advanced periauricular cutaneous malignancies with temporal bone involvement and to study treatment outcomes and prognostic factors predicting recurrence-free survival. Ten patients with advanced periauricular cutaneous malignancy with temporal bone involvement were identified. Patients with primary temporal bone or parotid gland malignancies were excluded. All patients were clinically T4 at presentation by the American Joint Committee on Cancer (AJCC) staging system. Using Pittsburgh staging, six were T1 (stage I) and four were T4 (stage III). The mean follow-up was 13.6 months (3 to 24 months). Patients with basal cell carcinoma were managed with wide local excision and lateral temporal bone resection (WLE/LTBR) without adjuvant therapy. Two of three (66%) are alive and free of disease; one patient died of other causes. Treatment for squamous cell carcinoma patients involved multimodality therapy. Kaplan-Meier survival curves show a worse prognosis in terms of disease-specific survival for patients with higher-staged PSS tumors. This did not reach statistical significance. The PSS may provide additional prognostic information on advanced cutaneous malignancies of the temporal bone over the more widely used AJCC staging system. However, further prospective multicenter studies with larger sample size are required to validate our findings. Basal cell carcinoma was well controlled with WLE/ LTBR alone without adjuvant therapy, whereas squamous cell carcinoma required multimodality therapy: WLE/LTBR and postoperative radiation with or without chemotherapy.KEYWORDS: Pittsburgh staging system, periauricular cutaneous malignancy, temporal bone Skin cancer is the most common malignancy in the United States. More than one million cases of nonmelanoma skin cancers were expected to be diagnosed in 2009. 1 The head and neck region is a largely sun-exposed area and accounts for the location of at least 75% of skin cancers. The auricle and periauricular area are the site of origin in 5% to 10% of all nonmelanoma skin cancers.2 Basal cell carcinoma (BCC) is the most common histological type, accounting for 85% of all skin cancers, whereas squamous cell carcinoma (SCC)

Institutional Experience of Treatment and Outcomes for Cutaneous Periauricular Squamous Cell Carcinoma

“…Our recurrence rate is higher than previous reports estimating any recurrence of periauricular SCC as roughly 10%. 23 In our study, small tumors arising within previous periauricular surgical beds were classified as recurrent disease, though it is possible that these in fact were new primaries. As expected, extent and morbidity of reoperation for treatment of locoregionally recurrent disease were considerable.…”

Temporal bone carcinoma. Current diagnostic, therapeutic, and prognostic concepts

“…An early diagnosis is crucial for prompt treatment and a good outcome. Although tumors involving the lateral third of the EAC or the pinna might be thought to have a better prognosis, cutaneous carcinomas in the periauricular region, and carcinoma involving the EAC in particular, are reportedly more aggressive than those arising in other areas of skin, probably due to multiple embryonic fusion planes facilitating tumor spread .…”

Malignancies requiring temporal bone resection: An Australian single‐institution experience

“…This was likely largely because most cancers in the cohort had a large soft issue component (>0.5 cm) and/or facial palsy—automatically earning T4 status. The eighth edition AJCC system has similar flaws, in that these tumours would be assigned T3 at a minimum for deep invasion, and T4b once the temporal bone is involved, regardless of extent 26,27 . Both systems can thus tend to over‐stage, resulting in the grouping of heterogenous tumours with vast differences in prognosis.…”