A case of Basal cell carcinoma of external auditory canal

Reconstruction of the external auditory canal: The tragal flap revisited and review of contemporary reconstructive techniques

BACKGROUND

Primary malignancies arising in the external auditory canal (EAC) are rare and usually are treated surgically. We review techniques to reconstruct the EAC following ablative surgery, and introduce a rarely utilized tragal skin flap which has particular advantages for reconstruction of limited anterior EAC defects.

METHODS

The terms "tragal flap", "external auditory canal", "preauricular tragal flap", "reconstructive techniques" were searched on PubMed and Google Scholar.

RESULTS

Our review identified one description of a tragal flap to reconstruct the EAC following resection of a malignancy. We add an additional case of a preauricular tragal flap to reconstruct the anterior EAC following resection of a recurrent basal cell carcinoma located in the EAC that led to a circumferential defect.

CONCLUSION

There are several surgical techniques that can be utilized to reconstruct the EAC. We describe a novel tragal flap used to reconstruct the anterior EAC following resection of a recurrent tumor.

Mohs Micrographic Surgery at Challenging Anatomical Sites

BACKGROUND

Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon.

OBJECTIVE

To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites.

METHODS

A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms.

CONCLUSION

These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.

Epidermal Carcinoma of the Conchal Bowl: Creation of a Multidisciplinary Pathway Approach

BACKGROUND

Malignant neoplasms of the auricle make up 6% of all skin cancers. Management of cutaneous neoplasms of the conchal bowl presents a unique challenge in visualizing and defining margins that may extend into the external auditory canal (EAC).

OBJECTIVES

The objective of this study was to create a multidisciplinary pathway for cutaneous carcinoma of the conchal bowl extending into the EAC.

METHODS

We present a series of patients that were referred to dermatology or otolaryngology, with cutaneous neoplasms arising in the conchal bowl. A consensus approach from otolaryngology and dermatology, for evaluation and treatment, was created based on evaluation of these cases, and review of the otolaryngology and dermatology literature, in collaboration between the two specialties.

RESULTS

Initial evaluation should be done by both dermatology and otolaryngology, with otomicroscopic evaluation of the canal. Imaging is recommended for lesions that approach the EAC, for bony and soft tissue spread. Excision of the tumor with Mohs micrographic surgery to achieve clearance in the conchal bowl should be performed initially. If extension into the external auditory meatus is present, otolaryngology would proceed with en bloc resection. Repair is dictated by the defect, with both specialties involved in follow-up.

CONCLUSIONS

In collaboration between dermatology and otolaryngology, and following review of the literature, a pathway was created to manage skin cancer of the conchal bowl. This resulted in a stepwise approach for evaluation and management, ensuring that patients have a streamlined pathway for the treatment of these lesions.

Metastasis of Breast Carcinoma to the External Auditory Canal: Report of an Unusual Case and Literature Review

We present a case of metastasis of the external auditory canal (EAC) from a primary breast carcinoma in a 53-year-old female with a review of the literature. The patient had been diagnosed with a primary carcinoma 4 years previously. The metastasis had developed recently in her left EAC and presented as a bulky, fleshy, bleeding mass. The mass was causing hearing loss on the left due to complete obstruction in the left EAC. The mass was incompletely removed with a surgical operation and histopathologically metastasis was proven. Although there are few case reports in the literature of various cancers metastasizing to the EAC, metastasis in the EAC from the breast carcinoma is exceedingly rare and only one case has been reported in the literature so far.