Malignant tumors of the external ear are rare, most of these tumors develop in the skin of the outer ear.
There are 2 types of external ear malignant tumors:
1. Basal cell carcinoma
It is commoner in fair people, especially those who are exposed to sun rays for long times, it occurs in the outer surface of the ear pinna.
- It starts as an itchy painless nodule which ulcerates later on.
- The ulcer has an inverted beaded edge, with necrotic floor and a hard base.
- No lymph nodes are detected except in case of secondaary infection, or transformation to squamous cell carcinoma.
Wide local excision with safety margin using Moh's technique (microscopically histopathologically- guided surrgery).
2. Squamous cell carcinoma
It may occur in the auricle (60%) or in the external auditor canal (30%) or as an invasion from the middle ear (10%).
- Chronic middle ear infection.
- Radium painters.
Symptoms of squamous cell carcinoma
- Diminution of hearing.
- Discharge, which is hemorrhagic.
- Pain (otalgia).
- Facial nerve paralysis.
Signs and staging of squamous cell carcinoma
- Stage I: Mass or ulcer in the auricle or external auditory canal skin without involvement of bone.
- Stage II: Involvement of the bony canal.
- Stage III: Involvement of the middle ear or mastoid, the patient starts to complain of facial paralysis.
Signs: Enlargement of the pre-auricular, pre-parotid and later on upper deep cervical lymph nodes.
- Biopsy is conclusive.
- C.T detects invasion of the bony canal, mastoid, middle ear and petrous bone.
Treatment of squamous cell carcinoma
- Stage I: Radical mastoidectomy with post-operative radiotherapy.
- Stage II: Partial temporal bone resection.
- Stage III: Subtotal temporal bone resection.