Lateral temporal bone resection for cutaneous carcinomas of the external auditory canal and peri-auricular region

Abstract

Objectives To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure. Methods A retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia. Results Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30). Conclusion Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup.

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

“…Patients undergoing salvage surgery were over two times more likely to recur than those undergoing definitive surgery. This finding was consistent with our previous study, and several others of primary temporal bone SCC and peri‐auricular cSCCs requiring TBR, highlighting the importance of achieving disease control in the first instance 5,9,11,31–34 . Additionally, involvement of the mandible, pterygoid muscle(s), and dura were all associated with increased risk of mortality.…”

“…Consistent with findings of other authors, invasion of the bony EAC was a significant prognostic factor for patients in this study, increasing the risk of disease recurrence by over four times on multivariable analysis. 5,25,[27][28][29] However, in our previous series, which included all patients with cSCC requiring TBR, pathological bone invasion did not affect survival outcomes. 9 We suspect this discrepancy may be due to a number of reasons.…”

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

“…The literature also remains divided on the prognostic significance of VII palsy. In their small study of 25 Australian patients who underwent LTBR for cSCC largely from peri‐temporal bone sites, Leedman et al found that clinical or radiological pre‐operative VII involvement significantly worsened OS 18 . However, McRackan et al found no statistically significant relationship between VII palsy and survival in their 60‐patient cohort, of which 93% were secondary cSCCs 19 .…”

“…McRacken et al and Gal et al revealed recurrence rates of 32% and 57% respectively for cSCCs of the peri‐auricular skin involving the temporal bone, but the average follow‐up was less than 26 months in both 19,21 . In their small Australian cohorts, Leedman et al found a 2‐year LRRFS of 82%, DSS of 75% and OS of 68%, while Kwok et al had a 2‐year DFS of 79%, DSS of 86%, and OS of 72% 18,22 . However, longer‐term follow‐up was lacking in these studies.…”

“… 19 , 21 In their small Australian cohorts, Leedman et al found a 2‐year LRRFS of 82%, DSS of 75% and OS of 68%, while Kwok et al had a 2‐year DFS of 79%, DSS of 86%, and OS of 72%. 18 , 22 However, longer‐term follow‐up was lacking in these studies.…”