Temporal Bone Resection in Advanced Periauricular Cutaneous Malignancy

Introduction: Primary temporal bone tumors are rare and aggressive, with an estimated incidence of 1 to 6 cases per 1 million population. However, cutaneous malignancies extending to the temporal bone, particularly squamous cell carcinomas (SCC), are a problem that deserves more attention. These tumors can be as difficult to manage and are often quoted to be more common than the primary subtype around the world. This certainly holds true in areas such as Queensland (Australia) and southern United States, where nonmelanoma skin cancer (NMSC) rates are extraordinarily high. Yet, a greater paucity of evidence exists on cutaneous malignancy involving the temporal bone, with very few series exclusively examining this specific disease entity.

Objective: To evaluate the epidemiology, patterns of spread, survival outcomes, and prognostic factors of patients with advanced cutaneous SCC extending to the temporal bone managed with temporal bone resection (TBR).

Methods: This is a retrospective study of all patients who underwent TBR for advanced periauricular cutaneous SCC at a tertiary care center between 2000 and 2019. Data were collected on demographics, clinical features, treatment, histopathology, and survival outcomes.

Results: A total of 175 patients underwent TBR for SCC. The most common site of origin was the preauricular region (48%). Concurrent perineural spread of the maxillary (V3) or facial (VII) nerves was present in 26% on preoperative imaging. Clear or close margins were achieved in 77%. Survival outcomes at 2 and 5 years for overall survival were 68 and 46%; for disease-free survival were 62 and 55%; and for disease-specific survival were 79 and 67%, respectively. Prognostic factors that reached statistical significance for worse prognosis included immunosuppression, preoperative VII palsy, preauricular subsite, positive surgical margins, perineural invasion, lymphovascular invasion, and pathological positive nodal disease.

Conclusion: This is the largest ever case series on cutaneous SCC extending to the temporal bone in published literature. These results provide valuable information regarding epidemiology and prognosis to both the clinician and patient.

Publikationsverlauf

Artikel online veröffentlicht:
12. Februar 2021