HISTORY: Surgical resection of the pinna had been performed 6 months earlier and the ear had not healed. Histopathologic analysis revealed squamous cell carcinoma.

PHYSICAL EXAMINATION: In addition to the left ear mass pictured, there was an oval 4 mm ulceration on a portion of the nasal planum.

DIAGNOSIS: Thoracic radiographs were normal.

TREATMENT :  In order to attempt excision of the remaining pinna and mass with clean margins, a left total ear canal ablation and lateral bulla osteotomy were necessary. Tissue was submitted for histopathologic analysis. The dorsolateral compartment of the bulla was impacted with purulent debris. Prior to closure, 3cc (55mg) of carboplatin was dispensed intralesionally at the surgical site. The nasal planum lesion was treated cryosurgically. Prophylactic oral antibiotic therapy was initiated.

OUTCOME:  Facial neuropraxia was present postoperatively secondary to manipulations necessary to excise grossly abnormal tissue. Despite aggressive resection, biopsy revealed recurrent well-differentiated SCC with extension to deep and lateral margins. The surgical site healed well, however despite intralesional chemotherapy, a recurrent palpable mass developed within 3 months postoperatively. The nasal planum lesion remained resolved.

DISCUSSION: Development of SCC is associated with solar irradiation, radiation therapy, petroleum-based chemicals and chronic trauma. Non-pigmented skin is more commonly affected, and a chronic non-healing wound is the most characteristic lesion.

Metastasis usually occurs via lymphatics initially, then blood. Complete surgical excision and/or cryotherapy are preferred treatment methods depending on the size and location of the lesion. Cryotherapy may be curative for small superficial lesions but local recurrence is common.

Intravenous cisplatin provides partial to complete remission of primary and metastatic lesions for 2-15 weeks. Intravenous administration postoperatively was declined in this case, therefore single intralesional cisplatin was performed in an attempt to provide the best chance for resolution.

If the tumor is detected and treated prior to enlargement and metastasis, the prognosis is favorable. Larger, more invasive tumors, such as in this case, are more difficult to treat and associated with a guarded prognosis. Sunscreen application to non-pigmented skin and reduced exposure to ultraviolet radiation are mandatory for patients diagnosed with SCC.