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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 26  |  Issue : 4  |  Page : 268-270

Basal cell carcinoma of pinna


Department of ENT, Dr. Babasaheb Ambedkar Memorial Hospital, Central Railway, Byculla, Mumbai, Maharashtra, India

Date of Submission03-Apr-2020
Date of Acceptance30-Apr-2020
Date of Web Publication23-Apr-2021

Correspondence Address:
Dr. Deepak Dalmia
Department of ENT, Dr. Babasaheb Ambedkar Central Railway Hospital, Byculla, Mumbai - 400 027, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_54_20

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  Abstract 


Basal cell carcinoma (BCC) is the most common malignant tumor of facial skin due to its anatomical characteristics; complete removal of BCC of pinna is a challenging task. Our study describes surgical excision with adequate margin as one of the treatment modalities. A 62-year-old male presented with a painless swelling over the left pinna (cymba conchae). Biopsy proved to be BCC. The mass was surgically excised with 0.5-cm margin, and the defect was closed with a split-thickness skin graft. Histopathological examination confirmed the diagnosis of BCC. The patient's postoperative healed scar is cosmetically acceptable, and he has no recurrence.

Keywords: Basal cell carcinoma of auricle, basal cell carcinoma of pinna, malignant tumor of head and neck, nonmelanoma skin cancer


How to cite this article:
Katakdhond HN, Patni P, Dalmia D, Davange N, Goyal R. Basal cell carcinoma of pinna. Indian J Otol 2020;26:268-70

How to cite this URL:
Katakdhond HN, Patni P, Dalmia D, Davange N, Goyal R. Basal cell carcinoma of pinna. Indian J Otol [serial online] 2020 [cited 2021 Dec 3];26:268-70. Available from: https://www.indianjotol.org/text.asp?2020/26/4/268/314351




  Introduction Top


Basal cell carcinoma (BCC) is the most common malignant tumor of the skin.[1] It is found on sun-exposed skin areas; about 80% of all lesions are found on the head and neck. It is invasive, locally destructive, and rarely metastatic.[1] The incidence of BCC in the Indian population is relatively less compared to fair skinned population.[2] Early diagnosis has better curability, less morbidity, and better surgical result.[3] The tumor has a high recurrence rate, and the patient has to be followed up for long time.[4]


  Case Report Top


A 62-year-old male, laborer, presented with a painless swelling on the left pinna (cymba conchae) for 2 years, and for 3 months, there was blood-stained purulent discharge from the mass. There was no history of ear surgery or facial trauma. He was diabetic and hypertensive, and there was no other significant medical history.

On clinical examination, there was a dark-pigmented lesion (1.5 cm × 1.0 cm), on the left cymba conchae, which was hard and nontender and fixed to the conchal cartilage. Other ear, nose, throat examination was normal. There were no other palpable masses in the head and neck. General physical examination was normal. Biopsy reported to be BCC.

On imaging, computed tomography scan showed no deep extension to the bone or external auditory canal. There were no enlarged neck lymph nodes. Preoperative laboratory tests were within normal limits.

After taking informed consent from the patient, under general anesthesia, the lesion was removed surgically with adequate margin of 0.5 cm all around. [Figure 1] The cymba conchae and adjacent cartilage was excised [Figure 2]; the defect was closed with a split-thickness skin graft without any reconstruction. [Figure 3] There were no immediate or postoperative complications.
Figure 1: Intraoperative picture with the excised specimen

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Figure 2: Defect after removal of lesion with adequate margin

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Figure 3: Defect closed with a split-thickness skin graft and sutured using 4-0 catgut

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Histopathological examination revealed to be BCC of pigmented type, and all margins and cartilage were free of tumor. The postoperative healed scar was cosmetically acceptable without any deformity. [Figure 4] On follow-up, the patient has no evidence of recurrence.
Figure 4: Postoperative picture after 3 months

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  Discussion Top


BCC is a common malignancy of skin, affecting mainly the sun-exposed area of head than other nonexposed parts of the body.[1] The sun-exposed areas such as ear pinna, nose, and malar region are mainly affected.[5] Males are more affected than females due to outdoor work.[2] BCC of the pinna has a high risk due to its nature of skin – thin skin, less adipose tissue, and adherent underlying cartilage tissue, making it more vulnerable to local spread, incomplete clearance, and high risk of recurrence.[6] BCC occurs due to damage to the DNA by ultraviolet (UV) radiation, which causes DNA hydroperoxide formation; it is usually detoxified by glutathione S transferase (GST), i.e. the polymorphism in GST leads to impaired detoxification. UV rays lead to the formation of pyrimidine dimer formation, loss of heterozygosity of both tumor suppressor genes TP 53 and PTCH.[1]

The clinical variants of BCC include nodular BCC, cystic, morpheaform, infiltrate, micronodular, superficial, and pigmented BCC.[2] Among the various modalities available are surgical (surgical/LASER excision, mohs surgery, curettage with or without cautery, and cryosurgery) and nonsurgical (radiotherapy, photodynamic therapy, topical chemotherapy with 5-flurouracil, imiquimod, and interferon alpha).[2] Surgical excision with adequate margins has the highest cure rate and low recurrence rate.[7],[8]

To the best of our knowledge, two cases have been reported in the Indian literature, in which Daoxian described a female patient with BCC that was diagnosed on the conchae of the right ear, and it was treated by LASER without reconstruction.

The second case was reported by Mohamed and Mohamed[6] who described a female patient with BCC that was diagnosed on the conchae of the right ear, and it was treated by surgical excision and wound was closed primarily. Ours is the third case of a male patient with proved BCC of cymba conchae, which was treated with surgical excision with adequate margins and the defect was closed with skin grafting without reconstruction, which healed well and is cosmetically acceptable.


  Conclusion Top


Knowing the high recurrence rate and locally destructive nature of the tumor, early diagnosis and proper management will give better results in patients. In our case of BCC of pinna, the tumor was removed completely with acceptable cosmetic appearance and no recurrence as per follow-up.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Flint P, Haughey B, Lund V, Niparko J, Robbins T, Thomas J et al. Cummings Otolaryngology – Head and Neck Surgery. 6th ed. Philadelphia: Elsevier; 2015.  Back to cited text no. 1
    
2.
Indian Association of Dermatologists, Venereologists, and Leprologists. IADVL Concise Textbook of Dermatology. 4th ed. Wiley India Pvt Ltd: John Wiley & Sons; 2013.  Back to cited text no. 2
    
3.
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. 3
    
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
    
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.
Mohamed E, Mohamed E. Basal cell carcinoma of the auricular concha. Indian J Otol 2017;2017:200-2.  Back to cited text no. 6
    
7.
Manstein CH, Manstein ME, 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. 7
    
8.
Nasser N, Filho NN, Neto BT, Silva LM. Giant basal cell carcinoma. An Bras Dermatol 2012;87:469-71.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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