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Squamous cell carcinoma of the external ear: 170 cases treated with Mohs surgery

  • Abel González
    Correspondence
    Corresponding author.
    Affiliations
    Angel H. Roffo Oncology Institute, Mohs Surgery Unit, Head and Neck Department, Alexander Fleming Institute, Skin Cancer Oncology, 1180 Cramer St., CABA (ZIP 1426), Buenos Aires, Argentina
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  • Dardo Etchichury
    Affiliations
    Angel H. Roffo Oncology Institute, Mohs Surgery Unit, Head and Neck Department, Alexander Fleming Institute, Skin Cancer Oncology, 1180 Cramer St., CABA (ZIP 1426), Buenos Aires, Argentina
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  • Juan Mario Rivero
    Affiliations
    Angel H. Roffo Oncology Institute, Mohs Surgery Unit, Head and Neck Department, Alexander Fleming Institute, Skin Cancer Oncology, 1180 Cramer St., CABA (ZIP 1426), Buenos Aires, Argentina
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  • Lucia Adamo
    Affiliations
    Angel H. Roffo Oncology Institute, Mohs Surgery Unit, Head and Neck Department, Alexander Fleming Institute, Skin Cancer Oncology, 1180 Cramer St., CABA (ZIP 1426), Buenos Aires, Argentina
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Published:April 07, 2021DOI:https://doi.org/10.1016/j.bjps.2021.03.060

      Summay

      Introduction

      Squamous cell carcinoma of the ear (SCC-E) shows high rates of local recurrence (LR) and lymph node metastases (NM). SCC-E is the leading cause of death from nonmelanoma skin cancer.

      Objective

      To determine the LR and NM rates and survival after Mohs micrographic surgery (MMS).

      Patients and methods

      We treated 170 invasive SCC-E with MMS with a mean follow up of 48 months. Mean age was 76 years, 93.2% were male patients, mean size: 1.5 cm, and 61.8% of the tumours were well differentiated.

      Results

      We observed 5 LRs, 2 locoregional recurrences, and 16 NMs in 23 patients. LR and NM rates were 4.1% and 10.6%, respectively. Only 3/25 recurrences occurred after 2 years of follow up. We observed 1(0.6%) distant metastasis (DM) in a patient who also presented LR + NM. Six out of seven cases with LR and 8/18 with NM died of disease, regardless of aggressive surgical rescue with or without adjuvant radiotherapy. Five-year overall survival, disease-free survival, and disease-specific survival were 81%, 82.6%, and 89.7%, respectively.

      Conclusions

      Undeniably, the outcome in SCC-E is determined by locoregional control. DM are sporadic and rarely the cause of death. Systematic reviews and retrospective studies show a solid trend in favor of MMS vs surgical excision. The LR rate of this series (4.1%) is one of the lowest published to date with regard to SCC-E, and confirms this assertion.
      We observed 10.6% NMs according to other series that treated the whole spectrum of SCC-E. Almost 2/3 of patients with NMs die after therapeutic rescue. We believe that it is essential to identify prognostic factors to select patients for one of the following: close surveillance (ultrasonography) during the first 2 years after surgery, sentinel node biopsy, or elective treatment of the nodes (surgery or radiotherapy).

      Keywords

      Abbreviations:

      AJCC (American Joint Committee on Cancer), BCC (basal cell carcinoma), cSCC (cutaneous squamous cell carcinoma), DFS (disease-free survival), DFSP (dermatofibrosarcoma protuberans), DOI (depth of invasion), DM (distant metastasis), DOD (died of disease), DSS (disease-specific survival), HN (head and neck), LNM (lymph node metastasis), LR (local recurrence), MMS (Mohs micrographic surgery), NED (no evidence of disease), OS (overall survival), PNI (perineural invasion), RCT (randomized control trial), RT (adjuvant radiotherapy), SCC (squamous cell carcinoma), SCC-E (squamous cell carcinoma of the ear), SE (standard excision)
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