Institutional Experience of Treatment and Outcomes for Cutaneous Periauricular Squamous Cell Carcinoma

Kevin J Kovatch; Joshua D Smith; Andrew C Birkeland; John E Hanks; Rasha Jawad; Scott A McLean; Alison B Durham; Ashok Srinivasan; Jonathan B McHugh; Gregory J Basura

doi:10.1177/2473974X19875077

Institutional Experience of Treatment and Outcomes for Cutaneous Periauricular Squamous Cell Carcinoma

OTO Open. 2019 Sep 13;3(3):2473974X19875077. doi: 10.1177/2473974X19875077. eCollection 2019 Jul-Sep.

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA.
² School of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
³ Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan, USA.
⁴ Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA.
⁵ Department of Pathology, Michigan Medicine, Ann Arbor, Michigan, USA.

Abstract

Objectives: To report our institutional experience, management, and outcomes of cutaneous periauricular squamous cell carcinoma (SCC).

Study design: Retrospective chart review.

Setting: Tertiary academic center.

Subjects: Patients undergoing treatment of cutaneous periauricular SCC from 2000 to 2016.

Results: A total of 112 patients had a median follow-up of 24.5 months, a mean ± SD age of 75.7 ± 10.6 years, and a strong male predominance (93.8%). Site distribution shows 87 (77.7%) auricular, 26 (23.2%) preauricular, and 10 (8.8%) postauricular lesions. Of auricular lesions, tumors involved the tragus (n = 3, 3.4%), helix/antihelix (n = 47, 54.0%), conchal bowl (n = 31, 35.6%), external auditory canal (n = 18, 16.1%), and lobule (n = 3, 3.4%). Most patients presented at stage I (52.7%) versus stages II (28.6%), III (6.3%), and IV (12.5%). Patients were largely treated surgically with primary tumor resection ranging from wide local excision to lateral temporal bone resection (± parotidectomy and neck dissection), with 17.0% and 5.4% receiving adjuvant radiation and chemoradiation, respectively. Metastatic spread was seen to the parotid (25.9%) and neck (26.8%), with most common cervical spread to level II. Overall survival, disease-specific survival, and disease-free survival at 3 years were 62%, 89%, and 56%, respectively. Nodal disease was associated with worse disease-specific survival (P < .001) and disease-free survival (P = .042). Pre- and postauricular sites were associated with worse overall survival (P = .007) relative to auricular sites.

Conclusion: Among cutaneous SCC, periauricular subsites pose treatment challenges related to surrounding anatomy and represent a unique tumor population. The reported propensity toward recurrence and patterns of metastasis may better guide treatment of aggressive tumors to include regional nodal dissection.

Keywords: cutaneous; periauricular; preauricular; squamous cell carcinoma.