Primary Malignant Tumors

Primary malignant tumors of the ear that are common among the elderly are squamous cell and basal cell carcinomas.

Squamous Cell Carcinoma

Squamous cell carcinoma should be considered in elderly patients with unexplained pinnal, auditory canal, or middle ear lesions, including chronic otitis media that is unexplained, prolonged, or in which there is granulation tissue. Squamous cell carcinoma, the most common malignant pinnal tumor, usually develops after age 40; the average age at diagnosis is 65. Squamous cell carcinoma is related to sun exposure and local trauma. It appears early as a thickened area of skin or as an ulcer. Pinnal tumors are usually painless; if they extend to the external auditory canal, they may cause a sensation of aural fullness, pruritus, and otorrhea.

Squamous cell carcinoma in the middle ear and mastoid may cause chronic ear infection. Advanced lesions cause deep and boring otalgia, serosanguineous drainage, and cranial neuropathies, including hearing loss.

Diagnosis is made after tissue biopsy and is often delayed because the lesion may closely resemble the granulation tissue of chronic suppurative otitis media. In such cases, the carcinoma may spread beyond the temporal bone or to the intrapetrous carotid artery. The prognosis is then very grave, regardless of treatment.

Treatment

Treatment of tumors confined to the pinna consists of wide local excision. The prognosis is good for patients with small tumors of the helix but not for patients with tumors near the opening of the external auditory canal.

The treatment of choice for carcinoma of the middle ear and mastoid is en bloc resection of the lesion, followed by radiation therapy. Because the temporal bone is near vital neurovascular structures, surgery frequently results in morbidity and mortality. In elderly patients with advanced carcinoma, surgical risks should be weighed carefully against the pain and debility associated with palliative care.

Basal Cell Carcinoma

Basal cell carcinoma, the 2nd most common malignant pinnal tumor, is most prevalent among elderly patients with a history of sun exposure. It appears as a nodule with pearly, heaped-up borders. Biopsy is required for definitive diagnosis. Basal cell carcinoma confined to the pinna may be managed with wide local excision or Mohs' surgery.

Although usually less aggressive than squamous cell carcinoma, basal cell carcinoma may also involve the external auditory canal, sometimes causing an unrelenting discharge. If it extends to deeper structures, hearing loss and facial nerve paralysis may occur. If the middle ear and facial nerve are not involved, the lateral temporal bone is resected, and the external auditory canal, tympanic membrane, malleus, and incus are removed; radiation therapy follows. If the middle ear and deeper structures are involved, surgery and radiation therapy or palliative therapy may be appropriate.

This topic was last updated June 2006.