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Basal cell carcinoma of the external auditory canal.

Carcinomas of the external auditory canal are rare, and they are associated with a relatively poor prognosis. Among these tumors, basal cell carcinomas are less common and less aggressive in nature.

A 42-year-old man presented with a 1-year history of on-and-off left-sided bloody otorrhea. He had visited other clinics and had been diagnosed with acute otitis externa. At our office, otoscopy revealed the presence of a nodular mass that had engaged the anterior aspect of the left cartilaginous portion of the external auditory canal (EAC) (figure). The lesion appeared to be benign. An incisional biopsy was performed with local anesthesia.

Contrary to our expectations, histologic examination was interpreted as a basal cell carcinoma. Further evaluation of the temporal bone by computed tomography and magnetic resonance imaging of the head and neck found no involvement of any other structure. The lesion was classified as a stage I T1N0M0 tumor. The solitary nodular tumor mass including the cartilage was removed via wide excision, with a 5-mm safe margin preserved. The defect was reconstructed with a split-thickness skin graft. No adjuvant chemotherapy or radiation was administered. One year after surgery, no evidence of local recurrence was found.

Carcinomas of the EAC are rare, with an annual incidence of approximately 1 per 1 million population. (1) Even large centers see only a few patients. Basal cell carcinomas of the EAC are known to be locally aggressive, although they are not associated with regional lymph node metastasis. Basal cell carcinomas are less lethal than other types of EAC carcinoma because of their slower growth rate and lack of metastasis. (2,3) Because of the rarity of basal cell carcinomas of the EAC, there is no consensus regarding their treatment and prognosis, but we know they can be removed with a minimum of safety concerns.


(1.) Kuhel WI, Hume CR, Selesnick SH. Cancer of the external auditory canal and temporal bone. Otolaryngol Clin North Am 1996;29 (5):827-52.

(2.) Testa JR, Fukuda Y, Kowalski LR Prognostic factors in carcinoma of the external auditory canal. Arch Otolaryngol Head Neck Surg 1997;123(7):720-4.

(3.) Brunner H. Basal-cell carcinoma of the external auditory canal and middle ear. AMA Arch Otolaryngol 1953;58(6):665-76.

Nai-Wei Hsueh, MD; Min-Tsan Shu, MD

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Author:Hsueh, Nai-Wei; Shu, Min-Tsan
Publication:Ear, Nose and Throat Journal
Article Type:Case study
Date:Oct 1, 2014
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