Applicability of the Pittsburgh Staging System for Advanced Cutaneous Malignancy of the Temporal Bone

Objective: To evaluate the applicability of the Pittsburgh staging system (designed for primary temporal bone malignancies) to advanced periauricular cutaneous malignancies of the temporal bone. To study treatment outcomes and prognostic factors predicting recurrence-free survival.

Methods: An Institutional Review Board–approved retrospective chart review was conducted to identify advanced periauricular cutaneous malignancies with temporal bone involvement that presented to our tertiary care medical center from 2001–2009. Demographic and clinical data, pathologic features and treatment details were recorded. Primary temporal bone malignancies were excluded.

Results: Ten patients were identified. All patients were clinically AJCC stage 4 at presentation; under Pittsburgh staging, six were T1 and four were T4. The mean follow-up for the cohort was 13.6 months (range, 3–24 months). Three patients with basal cell carcinoma (BCC) were Pittsburgh stage T1 and underwent surgery alone in the form of wide local excision (WLE) and lateral temporal bone resection (LTBR). All patients were disease free at a mean of 19 months. Seven patients had squamous cell carcinoma (SCC)(four were T4 and three were T1), of which 71%(5/7) received definitive surgical therapy with adjuvant radiation or chemoradiation therapy. Of the four patients with T4 disease, one died of disease at 3 months, one has active metastatic disease, and two are free of disease. Of the three patients with T1 disease, two are alive and free of disease and one died of disease.

Conclusions: Advanced cutaneous malignancy of the periauricular region that invades the external ear canal is rare. Basal cell carcinoma is well controlled with WLE/LTBR alone without adjuvant therapy, unless aggressive histological features dictate otherwise. Squamous cell carcinoma requires combined therapy: WLE/LTBR and postoperative radiation or chemoradiation therapy. Future studies with longer follow-up and a larger cohort through multicenter data pooling or meta-analysis are required to validate our observations and profile the biology of these rare tumors.