External Ear Basosquamous cell carcinoma Instructor Reporter 1

External Ear Basosquamous cell carcinoma Instructor: 杜宗陽主任 Reporter: 張廷碩 1

Case Presentation 2

History • • 44 -year-old female Sun exposure (+) Left progressive auricular mass for 2 years. 2014. 1. 14 EAR OPD 3

Physical Examination • A PURPLISH MASS LESION ABOUT 2 X 2 CM OVER LEFT UPPER AURICULAR. 4

Left auricle tumor 5

Operation • 2014. 1. 16: REMOVAL OF EXTERNAL EAR TUMOR +F. T. S. G 6

Left auricle skin defect FTSG repair on the skin defect skin 7

Pathology • It consists of one piece of grey white soft tissue and measures 1. 6 x 1. 4 x 1. 3 cm. • Nodular type basosquamous cell carcinoma. There is no tumor present at the resection margin. 8

Staging • • Neck CT Abdominal sonogram WBBS Staging: p. T 1 c. N 0 M 0 9

Risk Factors • The following are high-risk features for nonmelanoma skin cancer that is not on the eyelid: • The tumor is thicker than 2 millimeters. • The tumor is described as Clark level IV (has spread into the lower layer of the dermis) or Clark level V (has spread into the layer of fat below the skin). • The tumor has grown and spread along nerve pathways. • The tumor began on an ear or on a lip that has hair on it. 10

Staging • In stage I, The tumor is not larger than 2 centimeters at its widest point and may have one high-risk feature. • In stage II, the tumor is either: – larger than 2 centimeters at its widest point; or – any size and has two or more high-risk features • In stage III: Jaw, eye socket, or side of the skull /LN • In stage IV: base of the skull, spine, or ribs /LN>6 cm 11

Combined Conference • Pathology: – Margin less than 1 mm – No perineural invasion • Wider surgical margin is needed. • Post-op R/T is not indicated if margin free. 12

Operation • 2014. 2. 6: Tumor wide excision with primary closure 13

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Introduction 15

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History • First described in 1928. • Today’s definition: WHO 2005 • “Metatypical BCC” : Synonym to Basosquamous Cell Carcinoma • “Keratotic BCC” • “Collision tumor” 20