Epidermal Carcinoma of the Conchal Bowl: Creation of a Multidisciplinary Pathway Approach

Abstract

Background Malignant neoplasms of the auricle make up 6% of all skin cancers. Management of cutaneous neoplasms of the conchal bowl presents a unique challenge in visualizing and defining margins that may extend into the external auditory canal (EAC). Objectives The objective of this study was to create a multidisciplinary pathway for cutaneous carcinoma of the conchal bowl extending into the EAC. Methods We present a series of patients that were referred to dermatology or otolaryngology, with cutaneous neoplasms arising in the conchal bowl. A consensus approach from otolaryngology and dermatology, for evaluation and treatment, was created based on evaluation of these cases, and review of the otolaryngology and dermatology literature, in collaboration between the two specialties. Results Initial evaluation should be done by both dermatology and otolaryngology, with otomicroscopic evaluation of the canal. Imaging is recommended for lesions that approach the EAC, for bony and soft tissue spread. Excision of the tumor with Mohs micrographic surgery to achieve clearance in the conchal bowl should be performed initially. If extension into the external auditory meatus is present, otolaryngology would proceed with en bloc resection. Repair is dictated by the defect, with both specialties involved in follow-up. Conclusions In collaboration between dermatology and otolaryngology, and following review of the literature, a pathway was created to manage skin cancer of the conchal bowl. This resulted in a stepwise approach for evaluation and management, ensuring that patients have a streamlined pathway for the treatment of these lesions.

Treatment Algorithm for Basal Cell Carcinoma of the External Auditory Canal

“…1 Nearly 80% of MMS patients report pain on postoperative day (POD) 0, with approximately 40% continuing to have pain on POD 3. 2 Managing postoperative pain is critical for reducing patient anxiety and increasing likelihood of pursuing subsequent surgical treatment. 3 Current methods of postoperative analgesia are suboptimal.…”

“…MMS may be continued until the margins of resection approach the EAC. This margin was defined by Fraser and colleagues 2 as being within 1 to 2 millimeters of the external meatus, for tumors with well-defined or poorly defined borders.…”