Squamous Cell Carcinoma of Ear and Temporal Bone

Accounting for only a fraction of a percentage of all head and neck tumors, cancer of the ear and temporal bone is considered rare. Yet a common place for squamous cell carcinoma to develop when it does affect the ear is within the temporal bone.

• Squamous cell carcinoma is a form of skin cancer that develops within the middle and outer layer of skin in the ear canal
• This condition is life-threatening as the tumor can spread to the brain and the nerves around the ear.

While an exact cause of tumors that may affect the ear and temporal bone isn’t known, squamous cell carcinoma is commonly associated with ultraviolet light exposure. This usually comes from sun exposure on the outer ear or with exposure to artificial UV light sources. Some studies have linked tumors of the ear and temporal bone to skin irritations resulting from ear infections and ear drainage. Genetic abnormalities may also play a role in the development of squamous cell carcinoma. People with xeroderma pigmentosum (XP), an inherited sensitivity to UV light, are often more susceptible to skin cancers.

Firm, red nodules and sores on skin of the ear with a scaly crust are among the most common visible signs of squamous cell carcinoma. Patients may also notice discomfort in the affected ear. Most squamous cell carcinomas will grow and spread if left untreated, which often leads to hearing problems as the growth spreads deeper into the middle and inner ear. Some patients may also experience or notice:

• Ringing in the ear (tinnitus)
• Dizziness or disorientation (vertigo)
• Outer ear sores that don’t heal within 3-4 weeks

Diagnosis usually starts with an examination of the affected ear and a physical exam. Health history is also considered, especially anything involving skin cancer or cancer in general. In order to confirm that an abnormal growth within the temporal bone of the ear is squamous cell carcinoma, a small tissue sample (biopsy) will be taken and tested to make a positive diagnosis.

A CT scan or MRI scan may be done to clearly identify the location of the growth and to determine if it has spread or not. This information will be used to determine the most appropriate way to remove the affected tissues. Since squamous cell carcinoma is a malignant growth, it’s more likely to have spread if it wasn’t detected early. Most squamous cell carcinomas can often be successfully and completely removed with surgery.

For ear canal tumors, an incision is often made behind the ear so the growth can be safely accessed and removed. A lateral temporal bone resection is typically done if the tumor is in the bony part of the ear or within the inner two-thirds of the ear canal. A novel procedure developed by Dr. Djalilian is to remove the lateral portion of the ear canal without disturbing the ear drum and has been found to be equal in controlling disease than the traditional lateral temporal bone resection. Radiation therapy is sometimes recommended to ensure that all affected tissues are treated.

Tumors deeper within the ear may require the removal of additional parts of the ear to access and remove the growth. Reconstruction surgery is done at another time after it’s confirmed that the squamous cell carcinoma is gone. For growths located closer to the opening of the affected ear, a sleeve resection (removal of skin of the ear canal) is usually recommended.

Patients will continue to be monitored after surgery to ensure that squamous cell carcinoma does not return. The extent of recovery will depend on the specific procedure that was performed and whether or not parts of the ear had to be removed to access the tumor. If the growth was limited to the ear canal, patients usually have no lingering issues with hearing.

Since most squamous cell carcinomas are believed to be related to prolonged ultraviolet (UV) radiation exposure, the most effective preventative measure is to be cautions with sun exposure, especially around the exposed areas of the ear. Risk factors for this type of cancer include having a family history of skin-related cancers, the use of tobacco products, age, and having a weakened immune system.