Tumours of the external ear

1. Rodent ulcer or Basal Cell Carcinoma: - present as an indolent ulcer on the edge of the auricle. It will erode the auricle, and the skull if neglected. The tumor does not have lymphatic spread. Treatment is through wide local excision. Local flaps or free grafts close the defect. The tumor is radio resistant.

2. Squamous Cell Carcinoma: - is also common and has a more aggressive course with the local lymph nodes affected. Solar acanthosis and hyperkeratosis are precancerous lesions. Treatment is through wide local excision with neck node dissection. Radiotherapy is usually reserved for recurrences.

3. Basi-squamous term is used to describe a rodent ulcer that has nodal metastasis.

4. Malignant melanoma: - is common in white races living in sunny areas e.g. Australia. Wide local excision with radical neck dissection is the treatment. The tumor is radio resistant.

5. Kaposi’ sarcoma in AIDS patients.

can be benign or malignant

1-Benign tumors as: -

• Exostosis of the external canal with bone growth due to irritation of the periosteum e.g. cold water in swimmer’s ear. If large ≫ occlusion of the canal ≫ conductive deafness. Treatment is by drilling the bones and widening the canal.

• Osteoma differs from exostosis in being solitary and pedunculated. Treated by excision.

• Fibrous dysplasia ≫ the external canal is involved as a part of the affected temporal bone. Ground glass appearance on X-rays or CT is diagnostic. Treatment is by drilling and recontouring of the affected bones.

2- Malignant tumors as squamous cell carcinoma (SCC). It originates deep in the canal. It presents early with ear discharge (may be bloody), and deafness. It is difficult to differentiate from the carcinoma of the middle ear. In fact the two conditions are dealt with as a one disease. It commonly complicates chronic otitis media, or the later disease may masquerade the cancer. Biopsy is diagnostic. Since most patients present lately, treatment is mostly palliative. Temporal bone resection is performed with radiotherapy. Results are usually poor as it is impossible to obtain a cancer free margin (the temporal bone hosts important structures as the carotid artery, the jugular vein, and the facial nerve).

Category: ENT Notes