Treatment and Outcomes for Cutaneous Periauricular Basal Cell Carcinoma: A 16‐Year Institutional Experience

Abstract

Objective To report a single institutional experience with the surgical management of cutaneous periauricular basal cell carcinoma. Study Design Retrospective chart review. Setting Tertiary academic center. Methods Retrospective chart review of 71 patients diagnosed with periauricular basal cell carcinoma managed surgically from 2000 to 2016. Data were analyzed with descriptive statistics. Results The median age at diagnosis was 73.0 years (interquartile range, 13.0). Of all lesions, 2.8% (n = 2) were preauricular, 80.3% (n = 57) auricular, and 16.9% (n=12) postauricular. Auricular subsites included conchal bowl (36.6%, n = 26), helix (21.1%, n = 15), antihelix (1.4%, n = 1), peritragus (5.6%, n = 4), triangular fossa (1.4%, n = 1), external auditory canal (2.8%, n = 2), and lobule skin (1.4%, n = 1). Surgical approach included wide local excision (80.3%, n = 57), partial auriculectomy (8.5%, n = 6), and total auriculectomy or other combinations of surgical methods (11.3%, n = 8). Due to aggressive pathology, 3 cases required concurrent parotidectomy, neck dissection, ear canal sleeve resection, or mastoidectomy. In sum, 52.1% (n = 37) of cases had clear margins on first pass in the operating room; 25.4% (n = 18) required further resection; and 12.7% (n = 9) demonstrated final positive/overturned margins read as negative from the frozen sections. Reconstruction included full-thickness (25.4%, n = 18) or superficial-thickness (29.6%, n = 21) skin grafts and local flap reconstruction (25.4%, n = 18), while 5.6% (n = 4) required combinations of free flap and/or other reconstruction techniques; 14.1% (n = 10) did not undergo formal reconstruction. Conclusion Periauricular basal cell carcinoma occurs in anatomically diverse locations in and around the ear, and multiple surgical methods are required for successful treatment.

Management of Cutaneous Head and Neck Squamous and Basal Cell Carcinomas for Immunocompromised Patients

“…An immunosuppressed patient diagnosed with BCC has 2–3 times the odds of having a more aggressive course than a non-immunosuppressed patient. Recommended excision margins follow the NCCN guidelines for high-risk BCC [ 2 , 3 , 78 , 81 , 82 , 83 ].…”

“…BCC is characterized by subclinical extension beyond the visible tumor and, for this reason, standard excision should include a margin of clinically normal-appearing skin [ 2 , 79 , 80 , 82 , 84 ]. The NCCN guidelines recommend the use of margin assessment via Moh’s surgery or intraoperative frozen sections [ 2 , 80 , 81 , 85 ].…”

Role of the otologist/neurotologist in managing auricular and periauricular cutaneous malignancies: A 10‐year otologic oncology experience

“…[4][5][6] As many cutaneous malignancies are associated with ultraviolet (UV) light (sun) exposure, the head and neck are especially vulnerable regions. 7,8 Data suggests that especially in melanoma, auricular and periauricular sites portend worse prognosis, likely due to the high UV light exposure and variable lymphatic drainage of the ear. 9,10 Due to increasing incidence and the aggressive nature of the many auricular and periauricular cutaneous malignancies, prompt diagnosis and treatment are imperative.…”

“…9,10 Due to increasing incidence and the aggressive nature of the many auricular and periauricular cutaneous malignancies, prompt diagnosis and treatment are imperative. 7,8,10,11 Because of the complex three-dimensional anatomy of the external ear, cutaneous malignancies in this region may go unnoticed by the patient and may be difficult to examine for providers who do not have the proper equipment such as a microscope or endoscope available. Otologists and neurotologists are well-suited to provide comprehensive surgical care for patients with auricular and periauricular cutaneous malignancies.…”

“…Approximately 30% of cutaneous SCCA and BCCA cases and 20% of melanoma cases are diagnosed in the head and neck region 4–6 . As many cutaneous malignancies are associated with ultraviolet (UV) light (sun) exposure, the head and neck are especially vulnerable regions 7,8 . Data suggests that especially in melanoma, auricular and periauricular sites portend worse prognosis, likely due to the high UV light exposure and variable lymphatic drainage of the ear 9,10 …”