Thursday, December 24, 2015

Post-Auricular Basal Cell

The patient is an 84 year-old man with a one to two week history of bleeding from a lesion in the sulcus behind the left ear and overlying the mastoid process.  He had noticed a tumor there for a longer period of time and has covered that with a Band-aid.  The area was recently traumatized and he was seen at the Dermatology Clinic. He has a history of basal cell carcinoma of the glabella.

O/E:  There is a 2 cm erosive lesion behind the left ear that extends over the mastoid bone. 

A shave biopsy was taken from two representative areas.

Clinical Photo:
Pathology:  Basal cell carcinoma. Probably nodular, but deeper areas may show other features

Diagnosis:  The pathology confirms the clinical impression of basal cell carcinoma.

Discussion:  This is a particularly worrisome area.  While some nonmelanoma skin cancers in octogenarians can be observed, lesions in this area can be invasive into the underlying bone.  For this reason, we will recommend Mohs micrographic surgery.

Invasive basal cell carcinoma of the temporal bone.
Gussack GS et. al.
Abstract: Basal cell carcinomas involving the ear represent a spectrum of diseases, from a small superficial auricular lesion to an advanced destructive malignancy invading the temporal bone. The biologic activity of the morphea-form basal cell carcinoma variant of tumor and a postauricular location predispose to an aggressive biologic pattern. Management requires a thorough evaluation with determination of the degree of cranial and possible intracranial invasion. These lesions usually can be managed with partial temporal bone resections, although prognosis for patients with advanced lesions may be poor.
(No proof of bone invasion in this case; however, this is a setting where one needs to consider it)

No comments:

Post a Comment

We welcome your comments. We endeavor to serve your patients and you. If you want us to respond, please add your name and email address. Some people have trouble uploading comments. In that case, please send comments directly to Thank you.