Das Plattenepithelkarzinom der Ohrmuschel

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 basosquamous cell carcinoma]

BACKGROUND

Basosquamous carcinoma (BSC) is a rare malignancy with specific histopathological features of both basal cell (BCC) and squamous cell carcinoma (SCC). Therefore, the histological diagnosis is challenging. Due to its low incidence there is no consensus on the surgical management of BSC.

PATIENTS AND METHODS

We describe the (immunohistological) diagnostic and therapeutic aspects of nine cases (8 male symbol : 1 female symbol, on average 68.6 years of age (range: 47-81)) of BSC. Of these, seven were located on the pinna, one on the forehead and zygomatic region and one in the retroauricular region.

RESULTS

Immunochemical staining for epithelial membrane antigen was negative (apart from the typical areas of epithelial pearl formation) and BerEP4 was positive in all cases. Therapy consisted of partial removal of the pinna in four, and total removal in three cases. One patient was treated by partial removal of the auricle with superficial parotidectomy and ipsilateral neck dissection. In the case of the carcinoma on the forehead, a local excision was performed. The median follow-up was 45 months. One patient had a local recurrence.

CONCLUSIONS

The histological diagnosis of BSC is confirmed by the use of EMA and BerEP4 immunohistological staining. Clinically, BSC is a rare, aggressive skin tumor. Despite the histological similarity to basal cell carcinoma, BSC has an imminent risk of metastasizing. Hence, therapy should be similar to that for SCC, taking into consideration the age and general state of the usually elderly patient.

Sentinel Lymph Node Biopsy in Cutaneous Squamous Cell Carcinoma: A Systematic Review of the English Literature

BACKGROUND

Although most cutaneous squamous cell carcinoma (SCC) is curable by a variety of treatment modalities, a small subset of tumors recur, metastasize, and result in death. Although risk factors for metastasis have been described, there are little data available on appropriate workup and staging of patients with high-risk SCC.

OBJECTIVE

We reviewed reported cases and case series of SCC in which sentinel lymph node biopsy (SLNB) was performed to determine whether further research is warranted in developing SLNB as a staging tool for patients with high-risk SCC.

METHODS

The English medical literature was reviewed for reports of SLNB in patients with cutaneous SCC. Data from anogenital and nonanogenital cases were collected and analyzed separately. The percentage of cases with a positive sentinel lymph node (SLN) was calculated. False negative and nondetection rates were tabulated. Rates of local recurrence, nodal and distant metastasis, and disease-specific death were reported.

RESULTS

A total of 607 patients with anogenital SCC and 85 patients with nonanogenital SCC were included in the analysis. A SLN could not be identified in 3% of anogenital and 4% of nonanogenital cases. SLNB was positive in 24% of anogenital and 21% of nonanogenital patients. False-negative rates as determined by completion lymphadenectomy were 4% (8/213) and 5% (1/20), respectively. Most false-negative results were reported in studies from 2000 or earlier in which the combination of radioisotope and blue dye was not used in the SLN localization process. Complications were reported rarely and were limited to hematoma, seroma, cutaneous lymphatic fistula, wound infection, and dehiscence.

CONCLUSIONS

Owing to the lack of controlled studies, it is premature to draw conclusions regarding the utility of SLNB in SCC. The available data, however, suggest that SLNB accurately diagnoses subclinical lymph node metastasis with few false-negative results and low morbidity. Controlled studies are needed to demonstrate whether early detection of subclinical nodal metastasis will lead to improved disease-free or overall survival for patients with high-risk SCC.

Squamous Cell Carcinoma of the Auricle Arising from Keloid after Radium Neddle Therapy

The squamous cell carcinoma (SCC) of the auricle was one of the common tumors of not only skin but also ear. SCC of the auricle was described to be the carcinoma of old age with some predisposing factors and keloid was known to be one of the predisposing factors for malignant tumors. Keloid and radium needle therapy were risk factors, latter the major, independently from each other and were reported to conclude in SCC depending on the duration for the keloid and the dose for the radium needle therapy. The increased age with the long duration of these predisposing factors should have to be kept in mind in every situation when these treatment modalities had been planned to. Surgical interventions should always be the first choice in the treatment of not only the carcinomas but also in keloids in selected cases.