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Bilateral auditory canal squamous cell carcinoma.HNO.
2006;54(1):41-5.
Only a small
number of cases of bilateral carcinomas of the external ear canal
have been described in the literature. We present the first case
of a 72 year old male patient with a bilateral squamous cell
carcinoma of the external ear canal at a very early stage. A
computed tomography of the temporal bone revealed a well-pneumatized
mastoid on both sides. Both external ear canals were filled with
soft tissue without radiological signs of destruction of the
adjacent bone. The carcinomas of the external ear canal were
surgically removed using a canal-wall down technique and a
selective neck dissection of regions II-IV. Histology confirmed a
well differentiated squamous cell carcinoma of the external ear
canal without lymph node metastasis on both sides (TNM
classification: pT1 G2 N0 M0 R0). Bilateral radiation therapy with
59.4 Gy resulted in stenosis of both ear canals. Hearing
rehabilitation was achieved with bone conductive hearing glasses.
Diagnosis und therapy of bilateral external ear carcinomas are
presented and discussed.
Histological
criteria and metastasis of squamous cell carcinoma of the pinna.Laryngorhinootologie.
2005 Jul;84(7):482-6.
INTRODUCTION:
According to the guidelines for cancer of the skin in the head and
neck region of the German association of Otolaryngology, Head and
Neck surgery squamous cell carcinoma (SCC) of the pinna are
classified by using the current TNM system of skin cancer. As soon
as cartilage is infiltrated, irrespective of other criteria like
tumour size, SCC of the thin skin of the pinna are classified as
T4 category. As therapy considerably depends on the TNM stage a
review of the prognostic value of cartilage infiltration as well
as other histological criteria seems to be justified. METHODS:
Medical records of all patients (n = 36) being operated for SCC of
the pinna between August 1988 and January 2004 at our department
were retrospectively analysed with regard to a statistical
correlation of histological criteria, cervical lymph node
metastases and prognosis. RESULTS: In 36 cases a histological
re-evaluation could be performed on the original tumour samples
(34 male symbol : 2 female symbol; average age was 76 years, with
an age interval of 54 - 99 years). 26 SCC cases were smaller than
2 cm, 8 cases between 2 and 5 cm and 2 cases bigger than 5 cm of
size. 36 % of SCC cases had infiltration of the auricular
cartilage. Statistical analysis did not show a statistical
correlation of either cartilage infiltration, tumour size bigger
than 2 cm or 1 cm, tumour grading and tumour depth with regard to
lymph node metastases. DISCUSSION: According to our results,
cartilage infiltration as single criterion of inclusion into a T4
category should be analysed cautiously. The anatomical peculiarity
of the pinna where cartilage lies directly beneath very thin skin
should be taken into account. A survey of a bigger group of
patients e. g. as a multicenter study would be desirable for such
a rare malignancy.
Squamous
cell carcinoma of the external ear. A carcinoma of old age which
requires individualized therapy planning.HNO.
2004 Jun;52(6):518-24.
METHODS: Data
for all patients with ear malignancies being operated in our
department between August 1988 and March 2001 were retrospectively
analyzed for tumor localisation, stage, biometric data,
anesthesiological risk factors, therapy and recurrence of the
disease. RESULTS: Thirty of 79 patients (29 male, one female;
average age 77.2 years, range 54-99 years) with cutaneous
malignancies of the external ear were diagnosed as SCC ( n=32 SCC).
A total of 17 SCC were smaller than 2 cm, 12 were between 2-5 cm,
and three were larger than 5 cm. Only two patients had regional
nodal disease, none had distant metastases. The anesthesiological
risk was estimated according to the recommendations of the
American Society of Anesthesiologists (ASA); 16/30 patients were
classified as group 3 or 4, having severe general disease with a
decrease in vitality or even vital risks. A total of 24 SSC were
primarily operated under local anesthesia. Depending on histology,
localisation and size of the SCC local excision, partial or total
removal of the auricle was performed. In the remaining 8/32 cases,
the primary intervention was performed under general anesthesia,
mostly in combination with an ipsilateral neck dissection and a
superficial parotidectomy. In 8/32 cases, the SCC had to be
re-operated after primary R1 resection. Altogether, eight patients
received radiotherapy. In 5/32 cases there was a recurrence of the
disease. The average follow-up period of the 13 patients who are
still alive is 50 months (17-113). One patient died as a result of
the metastasized SCC and 16 patients died due to other diseases.
DISCUSSION: Considering the high age and the age-associated
general diseases of the patients with SCC of the auricle,
differentiation between a radical concept of therapy and its risks
and possible therapy-related damage is important. Therefore,
individual concepts such as partial removal of the pinna without
neck dissection and parotidectomy for the N(0) stage are justified
if relevant anesthesiological risk factors have to be taken into
account.
Squamous epithelial
carcinomas of the external ear.HNO.
2001 Apr;49(4) : 283-8.
BACKGROUND
AND OBJECTIVE: Squamous cell carcinoma of the pinna seems to be
associated with a worse prognosis as compared to other locations.
PATIENTS/METHODS: We studied 88 patients treated between 1975 and
1990 for a squamous cell carcinoma of the pinna. RESULTS: Lymph
node metastases were present in eight cases (9%) prior to
treatment. Treatment was intended to be curative in 83 patients
(94%). Tumor therapy was operative in all cases. Radiotherapy was
instituted postoperatively in three patients; five patients (5.7%)
died due to the tumor. Of 83 curatively treated patients, only 2
died of tumor progression. The survival rate was 98% after 2 years
and 95% after 5 years. The recurrence rate was 7% after 1 year,
13% after 2 years, and 18% after 5 years. The outcome with regard
to local tumor control and survival was significantly poorer when
neck metastases were present. CONCLUSIONS: We recommend tumor
excision with wide margins (5-10 mm) as first-line treatment. Neck
dissection with parotidectomy is indicated when suspicious lymph
nodes are detected by ultrasound sonography, the tumor diameter is
> 4 cm, cartilaginous invasion is present, and vertical tumor
thickness is > 5 mm.
Squamous cell
carcinoma of the pinna: a 6-year study.Br
J Plast Surg. 1994 Mar;47(2):81-5.
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.
Squamous cell
carcinoma of the external ear: a review of 75 cases.
Otolaryngol Head Neck Surg. 1987 Sep;97(3):308-12.
Squamous cell
carcinoma of the external ear can be a potentially lethal lesion.
Although it is the most common cancer involving the pinna, the
variables that have the greatest impact on prognosis are still in
question. We reviewed 75 cases of squamous cell carcinoma of the
external ear to determine patterns of occurrence and treatment
failure. Forty patients had adequate follow-up for determination
of cancer control rates. Local control was successful with initial
treatment in 85% of the cases. The incidence of lymph node
metastases was 10%, whereas distant metastasis occurred in only
one patient (2.5%). This series differs from others in that most
patients were unselected and most of the lesions treated were
early (less than 1 cm). The significance of positive margins after
surgical excision is also analyzed.
Squamous cell
carcinoma of the pinna.Br
J Plast Surg. 1983;36(2):171-5
A number of
cases of squamous carcinoma of the pinna were examined. The rate
and pattern of metastases were established and a review of the
histology carried out. No histological parameters could be
identified at the initial resection that were useful in predicting
the likelihood of metastases. The importance of adequate initial
surgery is emphasised.
Guidelines for
prophylactic radical lymph node dissection in cases of carcinoma
of the external ear.Head
Neck Surg. 1980 May-Jun;2(5):361-5.
All cases of
squamous-cell carcinoma of the external ear that were treated at
the ENT Clinic, University Hospital, Lund, Sweden, between 1970
and 1977 were analyzed retrospectively to determine parameters for
predicting the development of metastases. These cases included 62
males and 3 females, with a mean age of 77 years. The frequency of
metastases for these patients was 16.4%. The carcinomas were
graded according to four parameters: depth of growth, mode of
invasion, cellular differentiation, and cellular plasmolymphocytic
response. We concluded that depth of growth and mode of invasion
were the most useful of these parameters and that prophylactic
lymph node dissection should be performed in cases of tumors
larger than 4 cm in diameter, of tumors infiltrating the
cartilage, and of smaller tumors with maximum scores for depth of
growth and mode of invasion.
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