title: Basal cell carcinomas of the ear are more aggressive than on other head and neck locations.
abstract: BACKGROUND
  On pathology review, basal cell carcinomas (BCCs) on the ear more commonly present as aggressive subtypes. It is unclear if this histologic observation translates into more clinically aggressive tumors.
  
  
  OBJECTIVE
  We sought to determine the clinical aggressiveness of ear BCCs compared with BCCs elsewhere on the head and neck.
  
  
  METHODS
  We conducted a retrospective chart review of all BCCs treated at an academic center from 2005 through 2012. Subjects were divided into ear and non-ear groups. Subtypes classified as "aggressive" included morpheaform, infiltrative, micronodular, adenoid, metatypical, and mixed histology.
  
  
  RESULTS
  Of the 7732 head and neck BCCs, 758 (9.8%) were on the ear. Ear BCCs presented as larger lesions (1.28 vs 0.98 cm(2)), required more Mohs layers (16.5% vs 10.7%), and produced a larger final defect (4.29 vs 3.49 cm(2)) than non-ear lesions. When comparing only aggressive subtypes, ear BCCs also presented as larger lesions (1.42 vs 1.23 cm(2)), more frequently required 3 or more layers for clearance (22.3% vs 14.2%), and produced a larger final defect (4.92 vs 4.21 cm(2)) than non-ear lesions.
  
  
  CONCLUSIONS
  Limitations include single-center design and lack of long-term follow-up.
  
  
  CONCLUSIONS
  Ear BCCs appear to exhibit greater subclinical extension compared with non-ear head and neck BCCs. Therefore, the ear should be considered a high-risk location for BCCs.
authors.affiliation: Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Mulvaney
authors.affiliation: Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: H William
authors.initials: HW
authors.lastname: Higgins
authors.affiliation: Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Dufresne
authors.affiliation: Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Antonio P
authors.initials: AP
authors.lastname: Cruz
authors.affiliation: Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island. Electronic address: kachiu@gmail.com.
authors.forename: Kachiu C
authors.initials: KC
authors.lastname: Lee
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000601:surgery; D004428:Ear Neoplasms / Q000473:pathology* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D015580:Mohs Surgery; D012189:Retrospective Studies
keywords: Mohs micrographic surgery; anatomic location; basal cell carcinoma; nonmelanoma skin cancer; subclinical extension; tumor histology