← All decks
ENT
Cutaneous Malignancies of the Pinna and External Auditory Canal
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
12 sections · 146 slides
Overview
- Scope of this topic
- Roadmap
Anatomy
- Structure of the pinna
- Cartilaginous and osseous external auditory canal
- Fissures of Santorini
- Regional composition of the ear canal
- Sagittal section of the ear and canal
- Isolated temporal bone specimen
Epidemiology and risk
- Keratinocyte carcinoma terminology
- Incidence of keratinocyte carcinoma
- Site distribution on the head and neck
- Ultraviolet radiation and cutaneous carcinogenesis
- Pattern of ultraviolet exposure by tumour type
- Additional risk factors for keratinocyte carcinoma
- Skin cancer after solid organ transplantation
- Immunosuppressive regimen and skin cancer risk
Clinical evaluation
- History in suspected auricular or canal malignancy
- Family history and inherited syndromes
- Presenting features of canal and temporal bone cancer
- Most common signs and symptoms of EAC and temporal bone malignancies
- Head and neck examination
- Signs of deep and perineural invasion
Differential diagnosis
- Approach to a skin lesion of the ear
- Classification of cutaneous malignancies of the ear
- Actinic keratosis
- Actinic keratosis on the auricle
- Basal keratinocyte atypia on histology
- Squamous cell carcinoma: clinical appearance
- Invasive squamous cell carcinoma on histology
- Basal cell carcinoma: clinical appearance
- Malignant melanoma: the ABCD features
- Merkel cell carcinoma
- Ceruminous adenocarcinoma and adenoid cystic carcinoma
- Cutaneous sarcomas of the auricle
- Lymphoproliferative and other auricular lesions
Malignancies of the pinna
- High-risk features prompting imaging of a pinna tumour
- Imaging modalities for tumours of the pinna
- Staging frameworks for cutaneous malignancy
- TNM classification for skin carcinoma of the head and neck
- TNM classification for skin carcinoma of the head and neck (continued)
- TNM classification for skin carcinoma of the head and neck (continued)
- TNM classification for skin carcinoma of the head and neck (continued)
- Stage grouping for skin carcinoma of the head and neck
- TNM clinical classification for malignant melanoma of the skin
- TNM clinical classification for malignant melanoma of the skin (continued)
- TNM clinical classification for malignant melanoma of the skin (continued)
- TNM clinical classification for malignant melanoma of the skin (continued)
- Stage grouping for cutaneous malignant melanoma
- Stage grouping for cutaneous malignant melanoma (continued)
Treatment of pinna malignancy
- Topical 5-fluorouracil and imiquimod
- Photodynamic therapy
- Cryosurgery, electrodessication and curettage
- Principles of wide local excision on the pinna
- Excision margins for keratinocyte carcinoma
- Argument for treating all auricular KC as high risk
- Mohs micrographic surgery
- Surgery for malignant melanoma of the pinna
- Reconstruction after auricular tumour removal
- Primary radiation therapy for pinna malignancy
- Caccialanza radiotherapy series
- Radiation-induced malignancy and other sequelae
Regional nodal disease
- Metastatic risk of auricular keratinocyte carcinoma
- Predictors of regional metastasis
- Distant metastasis in keratinocyte carcinoma
- Therapeutic and elective nodal dissection
- Elective parotidectomy: conflicting evidence
- Neck management when parotid metastasis is found
- Sentinel lymph node biopsy
- Adjuvant therapy for advanced pinna malignancy
- Vismodegib in advanced basal cell carcinoma
- Interferon alpha-2 in melanoma
Malignancies of the external auditory canal
- Imaging in external auditory canal malignancy
- Metastatic rates in canal and temporal bone carcinoma
- Absence of a universal staging system
- Common features of the proposed staging systems
- Staging system proposed by Stell and McCormack [ 84 ]
- University of Cincinnati Grading System for temporal bone tumors [ 2 ]
- Staging system as proposed by Manolidis et al. [ 83 ]
- Pittsburgh staging system: origin and status
- Pittsburgh staging system for squamous cell carcinoma of the external auditory canal (2000) [ 73 ]
- Pittsburgh staging system for squamous cell carcinoma of the external auditory canal (2000) [ 73 ] (continued)
- Stage grouping in the Pittsburgh system
- Histological distribution of temporal bone malignancy
- Malignancies of the temporal bone
- Malignancies of the temporal bone (continued)
Treatment of canal malignancy
- Basis for treatment decisions in canal malignancy
- Primary radiation therapy for canal malignancy
- Definitive chemoradiotherapy for advanced canal SCC
- Principles governing extent of resection
- Operation selected by extent of tumour
- Transannular spread and its prognostic weight
- En bloc versus piecemeal resection
- Kinney and Wood approach to advanced tumours
- Facial nerve and carotid involvement
- Sleeve resection
- Lateral temporal bone resection: definition
- Incisions for lateral temporal bone resection
- Exposure and specimen in lateral temporal bone resection
- Bony steps of lateral temporal bone resection
- Fracture of the anterior canal wall
- Modified lateral temporal bone resection
- Subtotal temporal bone resection
- Exposure for subtotal temporal bone resection
- Total temporal bone resection
- Management of the N0 neck in canal malignancy
- Arguments for elective neck dissection as staging
- Adjuvant radiation for advanced canal SCC
- Stereotactic radiosurgery and adjuvant chemotherapy
Rehabilitation and outcomes
- Hearing loss after treatment of canal malignancy
- Osseointegrated bone conduction implants
- Interpreting published survival data
- Selection of published survival rates for malignancies of the EAC and temporal bone
- Selection of published survival rates for malignancies of the EAC and temporal bone (continued)
- Selection of published survival rates for malignancies of the EAC and temporal bone: reported survival
- Selection of published survival rates for malignancies of the EAC and temporal bone: reported survival (continued)
- Abbreviations used in the survival table
- Immunotherapy in advanced cutaneous SCC
- Summary
- Points worth carrying away
References
- References
- References
- References
- References
- References
- References
- References
- References
- References
- References
- References
- References
- References
- References
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
- Join our WhatsApp groups