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CASE REPORT
Year : 2017  |  Volume : 23  |  Issue : 3  |  Page : 200-202

Basal cell carcinoma of the Auricular concha


Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Date of Web Publication31-Aug-2017

Correspondence Address:
Mohammad Waheed El-Anwar
Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_105_16

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  Abstract 

Basal cell carcinoma (BCC) is the most common skin cancer. Eighty percent of BCC affect the facial skin. The important challenge is removing all tumor cells to avoid recurrence because recurrent tumor is more difficult to cure. The current study describes the first surgically removed BCC of the concha and describes its management. A 65-year-old woman presented with left painless fixed conchal swelling proved by punch biopsy to be BCC. This mass was totally removed with 0.5 safety margin with excision of all the conchal cartilage and lower part of ascending ramus of the helix. Postauricular raw area was left to be healed with frequent dressing. Histopathological examination confirmed the diagnosis of BCC and proved free surgical margin. The patient was cosmetically satisfied and symptom free up to date without complication or recurrence. A case of BCC of the conchae was reported and could be safely and completely removed. This directs surgeon attention to BCC as a cause of conchal swelling as an early diagnosis when it is still small allows easy, safe removal without the need for reconstruction.

Keywords: Auricle, basal cell carcinoma, ear


How to cite this article:
El-Anwar MW, Salah M. Basal cell carcinoma of the Auricular concha. Indian J Otol 2017;23:200-2

How to cite this URL:
El-Anwar MW, Salah M. Basal cell carcinoma of the Auricular concha. Indian J Otol [serial online] 2017 [cited 2020 Feb 25];23:200-2. Available from: http://www.indianjotol.org/text.asp?2017/23/3/200/213859


  Introduction Top


Basal cell carcinoma (BCC) is by far the most prevalent skin cancer. Eighty percent of BCC affect the facial skin. The greatest challenge is removing all tumor cells to prevent a recurrence because recurrent tumor is more difficult to cure.[1]

BCC usually grows only by local extension in both horizontal and vertical directions and can invade the deeper tissues, such as cartilage and bone.[2] It rarely metastasizes, but it is malignant causing significant destruction and disfigurement by invading surrounding tissues.[3] It is almost always curable when diagnosed and treated early.[4]


  Case Report Top


A 65-year-old female, homemaker, presented with painless swelling on the conchae of the right auricle that slowly increases in size over 2 years. Over the past 2 months, blood and pus oozed from the mass. She had no history of facial trauma or ear surgery. Apart from diabetes mellitus, she had no significant medical history. On clinical examination, hard, nontender nodular mass (2.5 cm × 2 cm) was detected on the right conchae with broad indurated base fixed to the conchal cartilage [Figure 1]. There were no other palpable masses in the head and neck region, and other otolaryngological examination was normal. General examination revealed no cutaneous or soft tissue tumors. Biopsy revealed BCC.
Figure 1: (a) Preoperative view of the conchal lesion. (b) Postoperative view after complete excision with free surgical margins. (c) one month postoperative

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Computed tomography scan showed no deep extension to bone or external auditory canal with no reported neck lymph nodes. Routine preoperative laboratory tests were within normal limits.

After an informed consent form was signed by the patient, under general anesthesia, the mass was surgically removed with minimum 0.5 cm safety margin all around with complete excision of the conchal cartilage and excision of lower part of ascending ramus of the helix [Figure 2]. The wound was primarily closed around remaining auricular cartilage while postauricular exposed area on top of postauricular muscles was left to be healed with frequent dressing [Figure 1] and [Figure 2]. The postoperative course was uneventful and the patient was discharged at the same day of surgery without complaint.
Figure 2: Operative views (a) begin of removal with safety margin determination. (b) Separation of the tumor with its safety margins. (c) Removed specimen and left raw area

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A histological examination confirmed the diagnosis of BCC of solid type and proved free all surgical margins.

The patient was cosmetically satisfied and symptom free up to date without any complication. Moreover, a clinical examination revealed no recurrence or other pathologies [Figure 1].


  Discussion Top


BCC is almost exclusively found in the head and neck with rare involvement of trunk and extremities. This tumor is commonly diagnosed on nose, eyelids, at the inner can thus of eyes, and behind the ears.[5]

To the best of our knowledge, only one case was previously reported in the literatures up to date [3] in which Daoxian et al.[6] described female patients had BCC that was diagnosed on conchae of the right ear and it was treated by LASER without reconstruction [Table 1].
Table 1: Differences between the current reported basal cell carcinoma of the conchae and previously reported one

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We reported a case of proved conchal BCC. The current reported conchal BCC was histologically proved as conventional without a history of exposure to the risk factors of BCC. Unlike the previously reported case,[6] as it was colorless, cauliflower in shape, much larger (about 2.5 cm × 2 cm), and has broad base fixed to the conchal cartilage [Table 1].

BCC of conchae is a common tumor in an uncommon location, where it is difficult to have an operation. The special location of BCC on the conchae often leads to misdiagnosis. Besides, it is difficult to perform surgery and apply suture on that anatomical area.[6]

A 0.4 cm margin will excise BCC with a 95% 5-year cure rate provided the tumor is at low risk.[7] The current case had low-risk criteria except that its size >2 cm. This was not a small BCC, but it was not giant BCC and did not invade surrounding structure. Hence, we did a surgical excision with at least 0.5 cm margins and achieved histologically free margins. It is said that Mohs micrographic surgery or excision with complete circumferential peripheral and deep margin assessment with frozen sections is recommended in high-risk and recurrent cases.[7] We depended on permanent sections that more accurate. In addition, our case was not recurrent or giant BCC as its size <5 cm.[8] Thus, we agree that radical surgical excision with microscopically tumor-free margins remains the treatment of choice for BCC because it is associated with a satisfactory disease-free survival, as previously reported.[2],[8]

It is important to diagnose BCC when it is small in size before reaching large size enough to disturb nearby structures as external auditory canal, mastoid, and facial nerve that may make surgery more difficult and hazardous. While, when it is still small, it could be safely and completely resected.

To the best of our knowledge, this is the second case of BCC of the auricular conchae to be reported and the first conchal BCC that was surgically removed successfully. Therefore, BCC should be considered in the differential diagnosis of tumors of conchae, and cure could be achieved with excision with safety margins giving acceptable cosmetic result without reconstruction.


  Conclusion Top


A case of BCC of the conchae was reported and could be safely and completely removed. This directs surgeon attention to BCC as a cause of conchal swelling as an early diagnosis when it is still small allows easy safe removal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hajdarbegovic E, Van der Leest RJ, Munte K, Thio HB, Neumann HA. Neoplasms of the facial skin. Clin Plast Surg 2009;36:319-34.  Back to cited text no. 1
[PUBMED]    
2.
Manstein CH, Mark E, Manstein ME, Omar E, Beidas OE. Giant basal cell carcinoma: 11-year follow-up and seven new cases. Plast Reconstr Surg 2011;128:1105-6.  Back to cited text no. 2
    
3.
Wong CS, Strange RC, Lear JT. Basal cell carcinoma. BMJ 2003;327:794-8.  Back to cited text no. 3
[PUBMED]    
4.
Butler DF, Parekh PK, Lenis A. Imiquimod 5% cream as adjunctive therapy for primary, solitary, nodular nasal basal cell carcinomas before Mohs micrographic surgery: A randomized, double blind, vehicle-controlled study. Dermatol Surg 2009;35:24-9.  Back to cited text no. 4
[PUBMED]    
5.
Tambe SA, Ghate SS, Jerajani HR. Adenoid type of basal cell carcinoma: Rare histopathological variant at an unusual location. Indian J Dermatol 2013;58:159.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Daoxian K, Kaihua Z, Qing Z, Lu W. A case of basal cell carcinoma on cavum conchae treated by carbon dioxide laser. Austin J Dermatol 2014;1:1025.  Back to cited text no. 6
    
7.
Huang CC, Boyce SM. Surgical margins of excision for basal cell carcinoma and squamous cell carcinoma. Semin Cutan Med Surg 2004;23:167-73.  Back to cited text no. 7
[PUBMED]    
8.
Nasser N, Nasser Filho N, Trauczynski Neto B, Silva LM. Giant basal cell carcinoma. An Bras Dermatol 2012;87:469-71.  Back to cited text no. 8
[PUBMED]    


    Figures

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    Tables

  [Table 1]



 

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