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

Abstract

ObjectivesTo report our institutional experience, management, and outcomes of cutaneous periauricular squamous cell carcinoma (SCC).Study DesignRetrospective chart review.SettingTertiary academic center.SubjectsPatients undergoing treatment of cutaneous periauricular SCC from 2000 to 2016.ResultsA total of 112 patients had a median follow-up of 24.5 months, a mean ± SD age of 75.7 ± 10.6 years, and a strong male predominance (93.8%). Site distribution shows 87 (77.7%) auricular, 26 (23.2%) preauricular, and 10 (8.8%) postauricular lesions. Of auricular lesions, tumors involved the tragus (n = 3, 3.4%), helix/antihelix (n = 47, 54.0%), conchal bowl (n = 31, 35.6%), external auditory canal (n = 18, 16.1%), and lobule (n = 3, 3.4%). Most patients presented at stage I (52.7%) versus stages II (28.6%), III (6.3%), and IV (12.5%). Patients were largely treated surgically with primary tumor resection ranging from wide local excision to lateral temporal bone resection (± parotidectomy and neck dissection), with 17.0% and 5.4% receiving adjuvant radiation and chemoradiation, respectively. Metastatic spread was seen to the parotid (25.9%) and neck (26.8%), with most common cervical spread to level II. Overall survival, disease-specific survival, and disease-free survival at 3 years were 62%, 89%, and 56%, respectively. Nodal disease was associated with worse disease-specific survival (P < .001) and disease-free survival (P = .042). Pre- and postauricular sites were associated with worse overall survival (P = .007) relative to auricular sites.ConclusionAmong cutaneous SCC, periauricular subsites pose treatment challenges related to surrounding anatomy and represent a unique tumor population. The reported propensity toward recurrence and patterns of metastasis may better guide treatment of aggressive tumors to include regional nodal dissection.

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

“…18 However, limited reports stratify the lesions to specific anatomic subsites. 19 Of all periauricular/auricular lesions, we found that most tumors arise primarily on the auricle (80.3%), though the true primary site location may be a blend of periauricular locations if we consider prior management of pre- and postauricular lesions by services other than otolaryngology or lesions managed with MMS. Within the auricle, most BCC occurred in the conchal bowl, followed by the helix, while very few cases (2.8%) were located in the EAC proper, consistent with typical anatomic regions with greater exposure to UV light.…”

Gene expression profiling for metastatic risk in head and neck cutaneous squamous cell carcinoma

“…The majority of cSCC tumors arise in the sun-exposed H&N region. 6,14,15 Successful treatment of primary cSCC-HN tumors can be complicated and extensive due to adjacent and underlying critical structures (e.g., skull base, eyes, facial nerve [CN VII], spinal accessory nerve, auditory canal, parotid gland). 14,32 High-risk tumors can have aggressive behavior with increased likelihood for metastasis and/or local recurrence.…”

“…Anatomical locations of the primary cSCC-HN tumor were categorized similarly to previous reports describing common sites of cSCC in the H&N region. 5,14,[25][26][27][28] Following comprehensive review of pathology reports and medical records, each case was completely staged via AJCC8 and BWH tumor staging systems [19][20][21] and categorized as very high, high, or low risk per current NCCN guideline definitions. 5 Characteristics and 40-GEP test results were analyzed for the cohort to determine significant differences between metastatic and nonmetastatic cases as previously described.…”

“…As the second most common form of skin cancer, cutaneous squamous cell carcinoma (cSCC) is diagnosed in approximately 1.8 million individuals each year in the United States, [1][2][3][4][5] and this high and rising incidence [1][2][3][4][5][6][7] corresponds to a substantial number of patients who develop metastasis (2%-6%). 5,[8][9][10][11][12][13] Over 50% of newly diagnosed cSCC lesions occur in the head and neck region (cSCC-HN), posing unique challenges for surgical treatment, 6,14,15 and cSCC-HN metastasis to nodal basins (e.g., parotid and cervical lymph nodes [LNs]) also complicates surgical and adjuvant treatment due to proximity of vital structures. In addition, regional and/or distant metastases in cSCC are associated with decreased survival; approximately 2% of cSCC patients die from the disease each year.…”

Adjuvant therapy for high‐risk cutaneous squamous cell carcinoma: 10‐year review

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 These high‐risk factors are often associated with more aggressive cancer growth, which can lead to recurrence, metastasis, and disease‐specific death (DSD). 1 , 8 Tumors located in the head and neck area account for more than 50% of new cSCC lesions, 9 , 10 are considered high risk by the National Comprehensive Cancer Network (NCCN) if located in the mask area of the face at any size or if located in other areas of the head and neck at ≥1 cm, 7 and pose unique challenges for surgical resection and treatment. The NCCN guidelines; as well as the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, Eighth Edition (AJCC8); Union for International Cancer Control (UICC), Eighth Edition; and Brigham and Women's Hospital (BWH) staging systems, use clinicopathologic features of the primary tumor to categorize risk of poor outcomes in cSCC.…”