Dermatologic surgery
Basal cell carcinomas of the ear are more aggressive than on other head and neck locations

Presented as a poster at the American Academy of Dermatology Summer Meeting, New York, NY, August 2, 2013.
https://doi.org/10.1016/j.jaad.2013.12.021Get rights and content

Background

On pathology review, basal cell carcinomas (BCCs) on the ear more commonly present as aggressive subtypes. It is unclear if this histologic observation translates into more clinically aggressive tumors.

Objective

We sought to determine the clinical aggressiveness of ear BCCs compared with BCCs elsewhere on the head and neck.

Methods

We conducted a retrospective chart review of all BCCs treated at an academic center from 2005 through 2012. Subjects were divided into ear and non-ear groups. Subtypes classified as “aggressive” included morpheaform, infiltrative, micronodular, adenoid, metatypical, and mixed histology.

Results

Of the 7732 head and neck BCCs, 758 (9.8%) were on the ear. Ear BCCs presented as larger lesions (1.28 vs 0.98 cm2), required more Mohs layers (16.5% vs 10.7%), and produced a larger final defect (4.29 vs 3.49 cm2) than non-ear lesions. When comparing only aggressive subtypes, ear BCCs also presented as larger lesions (1.42 vs 1.23 cm2), more frequently required 3 or more layers for clearance (22.3% vs 14.2%), and produced a larger final defect (4.92 vs 4.21 cm2) than non-ear lesions.

Limitations

Limitations include single-center design and lack of long-term follow-up.

Conclusion

Ear BCCs appear to exhibit greater subclinical extension compared with non-ear head and neck BCCs. Therefore, the ear should be considered a high-risk location for BCCs.

Section snippets

Methods

A retrospective chart review was conducted on all Mohs micrographic surgery cases performed from 2005 through 2011 at an academic center by 4 surgeons who were assisted by a fellow or resident. Tumors located on the head and neck were included and divided into ear and non-ear groups for comparison. Primary metrics included anatomic location, tumor type and subtype, initial tumor size and final defect area after extirpation, primary versus recurrent tumors, and number of Mohs stages taken.

Results

There was no significant difference in average age between subjects with BCCs on the ear compared with subjects with BCCs on non-ear locations (72.9 vs 69.5 years, P < .01). A disproportionate number of BCCs of the ears occurred in men (86%). By comparison, 57% of BCCs of non-ear locations occurred in men.

A total of 7732 head and neck BCC cases were reviewed, of which 758 (9.8%) were on the ear. Aggressive subtypes on the ear comprised 40% of the ear sample, compared with 33% of BCCs in non-ear

Discussion

Aggressive BCCs subtypes occurred more commonly on the ear compared with non-ear locations. Our study demonstrated the clinicopathological correlation in which aggressive BCC subtypes of the ear were more likely to require more Mohs stages to achieve tumor-free margins. Ear BCCs, even when controlled for subtype, presented as larger lesions and caused more subclinical tissue destruction than non-ear BCCs. The percentage of head and neck BCCs occurring on the ear was 9.8%, which was similar to

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Funding sources: None.

Conflicts of interest: None declared.

Reprints not available from the authors.

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