Patterns of regional metastasis in advanced stage cutaneous squamous cell carcinoma of the auricle

• Published in: Otolaryngology-head and neck surgery Vol. 144; no. 1; p. 36
• Main Authors: Peiffer, Nicholas, Kutz, Jr, J Walter, Myers, Larry L, Isaacson, Brandon, Sumer, Baran D, Truelson, John M, Ahn, Chul, Roland, Peter S
• Format: Journal Article
• Language: English
• Published: England 01.01.2011
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - therapy; Combined Modality Therapy; Ear Auricle; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Young Adult
• ISSN: 1097-6817
• DOI: 10.1177/0194599810390908

To determine patterns of regional metastasis in patients with advanced stage cutaneous squamous cell carcinoma of the auricle. Case series with chart review. University-based tertiary care hospitals. We analyzed 41 patients with stage III and IV squamous cell carcinoma of the auricle. The mean age was 74.2 years (range, 20.6-91.7 years). Thirty-five patients (85.4%) were stage IV. Twenty-nine patients (70.7%) had a prior history of nonauricular, nonmelanotic skin carcinoma. Twenty-four patients (58.5%) had regional metastasis to either the cervical or parotid nodal basin. In patients with cervical metastasis, the involvement by level was 6.7% (n = 1), 80.0% (n = 12), 46.6% (n = 7), 13.3% (n = 2), and 40.0% (n = 6), respectively. Of the 6 patients with a level 5 metastasis, 3 had primaries in the preauricular region, 2 had primaries of the auricle, and 1 had a primary of the postauricular region. Occult disease was present in 2 patients (9.1%) with cervical metastasis and in 4 patients (18.2%) with periparotid lymph node metastasis. Perineural invasion was seen in 84.4% of the study population. The recurrence rate was 46.3% (n = 19). The median time to recurrence was 28.3 months. Patients with advanced stage auricular cutaneous squamous cell carcinoma have a high rate of regional metastasis and recurrence. When planning neck dissections for these patients, level 5 should be included in the resection. Patients demonstrating locally advanced disease without clinical or radiographic evidence of metastasis to the parotid or cervical drainage basin should undergo a parotidectomy and comprehensive neck dissection.