Curettage-cryosurgery for non-melanoma skin cancer of the external ear: excellent 5-year results

A Study of Skin Disease of the External Ear in Older Adults According to Anatomical Location

Background

Due to its anatomical location, the external ear is easily exposed and damaged due to trauma, weathering, and inflammation. Therefore, depending on the patient’s age, different cutaneous diseases can occur. In addition, because of its small percentage of the overall body area, patients and doctors may miss observing dermatologic diseases of the ear. The purpose of this study was to provide information on the most common dermatologic diseases according to the location on the external ear.

Methods

This retrospective study was conducted on patients who visited the Department of Dermatology of Chosun University Hospital in the past 7 years.

Results

We included 269 patients and categorized their ear lesions according to 8 anatomical locations and 5 types of dermatologic diseases. In older patients over 60 years of age, the most common site of dermatologic disease was the postauricular region (33.9%), followed by the antihelix (19.4%), and earlobe (12.9%). The most common dermatologic disease was benign tumor (53.2%), followed by malignant and premalignant tumors (32.3% and 9.7%, respectively).

Conclusion

The proportion of older adults with premalignant and malignant diseases was relatively high and these were most commonly observed in the antihelix and postauricular area. Therefore, it is important to aware the need for the examination, diagnosis, and treatment of disease in the antihelix and postauricular area.

[Cryosurgery in dermatology]

This article provides information on the clinical development of skin reactions after cryosurgery/cryotherapy and the indications, complications and contraindications of skin cryosurgery. Successful skin cryosurgery requires rapid freezing and slow thawing, minimum tissue temperature of -25 to -60℃ and, in malignant lesions, repetition of the freeze-thaw cycle. Frozen tissue reacts with peripheral erythema immediately after thawing, followed by edema, bulla formation, exudation and mumification. Lesions usually heal with a fine atrophic scar after approximately 4 weeks. Nowadays, cryosurgery is considered the treatment of choice in hypertrophic scars and keloids, granuloma annulare, small capillary infantile hemangioma and isolated actinic keratoses. It is also a valuable alternative therapy for various other skin diseases, including common warts, solar lentigo, superficial basal cell carcinoma and Kaposi's sarcoma. Cryosurgery is a safe regimen with relatively few adverse effects and contraindications. Pain during and/or shortly after treatment, bulla formation and local edema are the major temporary adverse effects; lesional hypopigmentation and/or peripheral hyperpigmentation is the most common long-term complication.

Non-melanoma skin cancers: photodynamic therapy, cryotherapy, 5-fluorouracil, imiquimod, diclofenac, or what? Facts and controversies

Surgical modalities-excision, Mohs micrographic surgery, and electrodesiccation with curettage-are the preferred treatments for nonmelanoma skin cancer (NMSC). When used within guidelines, they have cure rates greater than 90%. Despite this, many other treatments have been studied and utilized for NMSC. We present a comprehensive review of the literature on these topical treatments. Photodynamic therapy (PDT) is administered under numerous and significantly varied regimens, and there are a wide range of cure rates reported. Even with aggressive regimens, PDT is not as effective as surgery is, and it is not a first-line therapy for NMSC. The cryotherapy regimen aggressive enough to adequately treat NMSC carries adverse effects and cosmetic outcomes poor enough to negate its usefulness. Topical 5-fluorouracil and imiquimod are efficacious and safe for the treatment of superficial basal cell carcinoma (BCC) but not other BCC subtypes or squamous cell carcinoma. They are self-administered twice daily for several weeks; therefore, patient and tumor selection are vital to ensuring adherence. There are currently insufficient data to support the use of topical diclofenac and ingenol mebutate for NMSC.

Prospective follow-up after curettage-cryosurgery for scalp and face skin cancers

BACKGROUND

Cryosurgery (CS) in the treatment of nonmelanoma skin cancers (NMSCs), especially in the face and on the scalp, has several advantages vs. other methods. Prospectively gathered long-term results after CS are, however, scarce.

OBJECTIVES

To establish long-term results after curettage and CS (CCS) of NMSCs in the face and on the scalp considering complication rate, patient tolerance, cosmetic outcome and rate of recurrence.

METHODS

Seven hundred and twenty-six patients with 962 face and scalp NMSCs were prospectively followed after CCS (1 week, 3 months, and then annually) during the time period December 1994-September 2008.

RESULTS

Mean/median follow-up time was 42/34 months (range 1 month-14 years). Forty-two of 962 (4.4%) received antibiotics due to clinical, superficial infections. No serious complications were recorded. Ninety-nine per cent of the women and 100% of the men graded the cosmetic outcome as 'good' on a three-level scale, follow-up rate 99%. Fifty-six (14%) women and 78 (23%) men (P = 0.001) developed one or more new NMSCs during the study period. Fourteen of 962 (1.5%) recurrences were recorded, in nine women and five men. An expected recurrence-free rate/cure rate of > 97% after 14 years was calculated (Kaplan-Meier).

CONCLUSIONS

CCS in the treatment of NMSCs is expedient and well tolerated, with no major and few minor complications. When performed as in the present study it produces good cosmetic results in virtually all cases, with an anticipated 97% cure rate after 14 years. CCS is thus a highly viable alternative in the treatment of NMSCs in the face and on the scalp.

Lymph node metastases from auricular squamous cell carcinoma. A systematic review and meta-analysis

INTRODUCTION

Squamous cell carcinoma arising on the auricle is believed to metastasise to the regional lymph nodes more frequently than comparable tumours at other sites. Metastatic spread of these tumours is associated with a poor outcome but there is no clear consensus of opinion on how to identify patients at risk of metastatic spread and treat them.

MATERIALS AND METHODS

A systematic review database search of Medline and Embase was conducted with cross referencing of articles.

RESULTS

The metastatic rate is 11.2% with spread to the parotid and upper deep cervical chain most common. Eighty-five per cent of metastases develop within 12 months and 98% within 24 months, although follow up was limited to 12 to 36 months in most cases. Death occurs in 6.2% of cases (about half of the patients who develop metastases) usually due to failure of loco-regional control. Depth of invasion, tumour size, degree of cellular differentiation and incomplete primary excision margins may be useful in identifying lesions most at risk of metastasising but there is insufficient evidence at present to allow targeted neck dissections.

Cutaneous lesions of the external ear

Skin diseases on the external aspect of the ear are seen in a variety of medical disciplines. Dermatologists, othorhinolaryngologists, general practitioners, general and plastic surgeons are regularly consulted regarding cutaneous lesions on the ear.

This article will focus on those diseases wherefore surgery or laser therapy is considered as a possible treatment option or which are potentially subject to surgical evaluation.

Therapeutic options for Bowen's disease

Multiple therapeutic options are available for treatment of Bowen's disease. The choice of therapy depends on clinical circumstance and medical practitioner experience. Newer therapies have more extensive support from the literature, but more established therapies may be preferred because of accessibility, cost and efficacy. An overview of the current therapeutic options for Bowen's disease is presented.

Curettage, electrosurgery and skin cancer

The scientific literature is replete with reports extolling the virtues of curettage and electrosurgery in the treatment of skin disease. Published cure rates for selected skin cancers consistently equal those for other treatment modalities, including scalpel excision. Despite this, curettage is often overlooked as a first line treatment for skin cancer. We review the evidence-based literature for patient selection criteria and curettage and electrosurgery techniques.