title: Patterns of regional metastasis in advanced stage cutaneous squamous cell carcinoma of the auricle.
abstract: OBJECTIVE
  To determine patterns of regional metastasis in patients with advanced stage cutaneous squamous cell carcinoma of the auricle.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  University-based tertiary care hospitals.
  
  
  METHODS
  We analyzed 41 patients with stage III and IV squamous cell carcinoma of the auricle.
  
  
  RESULTS
  The mean age was 74.2 years (range, 20.6-91.7 years). Thirty-five patients (85.4%) were stage IV. Twenty-nine patients (70.7%) had a prior history of nonauricular, nonmelanotic skin carcinoma. Twenty-four patients (58.5%) had regional metastasis to either the cervical or parotid nodal basin. In patients with cervical metastasis, the involvement by level was 6.7% (n = 1), 80.0% (n = 12), 46.6% (n = 7), 13.3% (n = 2), and 40.0% (n = 6), respectively. Of the 6 patients with a level 5 metastasis, 3 had primaries in the preauricular region, 2 had primaries of the auricle, and 1 had a primary of the postauricular region. Occult disease was present in 2 patients (9.1%) with cervical metastasis and in 4 patients (18.2%) with periparotid lymph node metastasis. Perineural invasion was seen in 84.4% of the study population. The recurrence rate was 46.3% (n = 19). The median time to recurrence was 28.3 months.
  
  
  CONCLUSIONS
  Patients with advanced stage auricular cutaneous squamous cell carcinoma have a high rate of regional metastasis and recurrence. When planning neck dissections for these patients, level 5 should be included in the resection. Patients demonstrating locally advanced disease without clinical or radiographic evidence of metastasis to the parotid or cervical drainage basin should undergo a parotidectomy and comprehensive neck dissection.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9035, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Peiffer
authors.forename: J Walter
authors.initials: JW
authors.lastname: Kutz
authors.forename: Larry L
authors.initials: LL
authors.lastname: Myers
authors.forename: Brandon
authors.initials: B
authors.lastname: Isaacson
authors.forename: Baran D
authors.initials: BD
authors.lastname: Sumer
authors.forename: John M
authors.initials: JM
authors.lastname: Truelson
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.forename: Peter S
authors.initials: PS
authors.lastname: Roland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D003131:Combined Modality Therapy; D054644:Ear Auricle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy; D055815:Young Adult