Squamous Cell Carcinoma Extending to the Temporal Bone

Anderson, Shane; Patel, Parag M.; Panizza, Benedict

doi:10.1007/978-81-322-2497-6_10

Cited by 3 publications

(11 citation statements)

References 27 publications

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“…Peri‐auricular cSCCs are known to be aggressive with higher locoregional recurrence and mortality rates than other head or neck subsites. They also tend to have high rates of incomplete or inadequate primary excision, possibly in efforts to limit morbidity (i.e., iatrogenic VII palsy) or due to an underestimation of medial spread of malignancy 7,16,17 . This was also reflected in this study, where 77.2% of patients had locoregionally recurrent or residual disease at diagnosis.…”

Section: Discussionmentioning

confidence: 68%

“…Spread to the temporal bone can result from three disease processes: (1) direct invasion of an advanced peri‐auricular cSCC, (2) metastatic extension from an involved peri‐auricular lymph node with cSCC; and (3) facial nerve (VII) perineural spread (PNS) from cSCC. Unlike primary external auditory canal (EAC) (or temporal bone) SCC, an extremely rare entity with an estimated incidence of 1–2 cases per million per year, secondary involvement of the temporal bone by cSCC arising from surrounding structures occurs more frequently 1–9 . This is especially the case in heavily sun exposed areas of the world where keratinocyte carcinoma (KC) is highly prevalent 10 .…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology and treatment outcomes of cutaneous squamous cell carcinoma extending to the temporal bone

et al. 2022

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Background Accurate epidemiological and outcomes data regarding cutaneous squamous cell carcinoma (cSCC) extending to the temporal bone is lacking. Methods Retrospective analysis of 167 Australian patients with primary and peri‐temporal bone cSCC. Results cSCC extending from secondary subsites (93.4%) was 14 times more frequent than primary temporal bone SCC (6.6%). For patients who underwent curative surgery ± post‐operative radiotherapy (n = 146, 87.4%), 5‐year disease‐free survival, locoregional recurrence‐free survival, disease‐specific survival, and overall survival was 53.0%, 59.4%, 67.9%, and 44.7%, respectively. External ear and pre‐auricular tumors, salvage surgery, tumor size (≥40 mm medial‐lateral), nodal disease, and involved margins were negative predictors of survival in multivariable analysis. Conclusion In regions of high sun exposure, cSCCs extending to the temporal bone are more common than primary cancers. Outcomes are improved with clear margins, justifying the need for radical resection. Further research regarding pre‐auricular cancers is required given poorer associated survival outcomes.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Epidemiology and treatment outcomes of cutaneous squamous cell carcinoma extending to the temporal bone

et al. 2022

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“…While authors have previously suggested that malignancy involving the temporal bone is most commonly due to extension of cancers of surrounding structures, few studies have examined this 1,7–9 . Instead, the literature remains largely dominated by studies of rare primary temporal bone tumours.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, achieving an en bloc negative margin excision without TBR is very difficult. Thus, as a basic principle in planning surgery, TBR allows for clearance of the medial margin and/or central neural margin, while additional procedures, such as parotidectomy and mandibulectomy, are used to obtain clear peripheral margins 2,8 . This radical approach can be seen in this study, with large proportions of patients undergoing parotidectomy (73.2%), VII sacrifice (56.9%) and TMJ or mandibular resections (44.5%), in addition to TBR.…”

Section: Discussionmentioning

confidence: 99%

“…Literature reports an incidence of one to two cases per million per year and a 5‐year overall survival (OS) of 50% 1–6 . However, secondary involvement of the temporal bone by cancers of surrounding structures has been quoted to occur more commonly than primary tumours around the world, and can be as aggressive and difficult to manage 1,7–10 . This certainly holds true in Queensland (Australia), where non‐melanoma skin cancer (NMSC) rates are extraordinarily high and temporal bone involvement is most commonly seen due to extension of cutaneous malignancies—largely squamous cell carcinoma (SCC).…”

Section: Introductionmentioning

confidence: 99%

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

Schachtel

Gandhi

Bowman

et al. 2021

ANZ Journal of Surgery

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Background Malignancies in and around the temporal bone are aggressive and difficult to manage. In Queensland (Australia), where skin cancer rates are exceedingly high, tumours extending to the temporal bone from surrounding structures occur more commonly than primary cancers. Yet, a paucity of evidence exists as to their management and outcomes. This study aimed to review an Australian centre's experience of managing temporal and peritemporal bone malignancies, reporting on patient and tumour characteristics, treatment, and survival outcomes. Methods Retrospective analysis of patients with primary temporal bone cancer and cancers extending to the temporal bone managed by the Queensland Skull Base Unit (Princess Alexandra Hospital) between 2000 and 2019. Results A total of 222 patients were identified, of which 203 (91.4%) had cutaneous primaries, with 167 (75.2%) being squamous cell carcinoma (SCC). 73.9% presented with locoregionally recurrent or residual disease. Secondary tumours (92.8%) were 12 times more frequent than primary malignancies (7.2%), with the preauricular subsite the most common (45.5%). In the 201 patients (90.5%) who underwent curative intent surgery, 5‐year overall survival, disease‐free survival (DFS), and disease‐specific survival was 46.6%, 52.2%, and 65.9%, respectively. The preauricular subsite (p = 0.004), melanoma (vs. SCC, p = 0.027), involved margins (p < 0.001), and pathologically involved nodes (p < 0.001) were associated with significantly worse DFS. Conclusion This is one of the largest studies of temporal bone malignancy in the literature, comprised primarily of secondary cutaneous malignancies. Although clear differences in epidemiological characteristics exist around the world, survival remains poor. Treatment should focus on achieving a clear margin of resection to optimize outcomes.

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Patterns of spread and anatomical prognostic factors of pre‐auricular cutaneous squamous cell carcinoma extending to the temporal bone

Schachtel,

Gandhi,

Bowman

et al. 2023

Head & Neck

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BackgroundImprovements can be made in the management and staging of advanced pre‐auricular cutaneous squamous cell carcinoma (cSCC). We aimed to analyze radiological patterns of spread and clinico‐anatomical prognostic factors.MethodsRetrospective review of 54 patients with pre‐auricular cSCC (cutaneous/nodal) who underwent temporal bone resection with curative intent.ResultsInvolvement of the cartilaginous external auditory canal (EAC) (79.6%) and retromandibular space (63.0%) was common. Styloid process/anterior carotid sheath (ACS) (11.1%) and bony EAC (7.4%) involvement were rare. ACS involvement resulted in high rates of involved surgical margins (100%) and poor outcomes on univariable analysis. Negative prognostic factors on multivariable analysis included salvage surgery and invasion of the bony EAC, mandible, pterygoid muscle(s), and dura.ConclusionThe bony EAC and ACS can form temporary barriers to tumor spread, with the latter representing a potential limit of resectability. Prognostic factors revealed can lead to the development of a more appropriate staging tool.

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Squamous Cell Carcinoma Extending to the Temporal Bone

Cited by 3 publications

References 27 publications

Epidemiology and treatment outcomes of cutaneous squamous cell carcinoma extending to the temporal bone

Epidemiology and treatment outcomes of cutaneous squamous cell carcinoma extending to the temporal bone

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

Patterns of spread and anatomical prognostic factors of pre‐auricular cutaneous squamous cell carcinoma extending to the temporal bone

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