ABSTRACT
The objectives are to evaluate the applicability of the Pittsburgh staging system
(PSS) (designed for primary temporal bone malignancies) to advanced periauricular
cutaneous malignancies with temporal bone involvement and to study treatment outcomes
and prognostic factors predicting recurrence-free survival. Ten patients with advanced
periauricular cutaneous malignancy with temporal bone involvement were identified.
Patients with primary temporal bone or parotid gland malignancies were excluded. All
patients were clinically T4 at presentation by the American Joint Committee on Cancer
(AJCC) staging system. Using Pittsburgh staging, six were T1 (stage I) and four were
T4 (stage III). The mean follow-up was 13.6 months (3 to 24 months). Patients with
basal cell carcinoma were managed with wide local excision and lateral temporal bone
resection (WLE/LTBR) without adjuvant therapy. Two of three (66%) are alive and free
of disease; one patient died of other causes. Treatment for squamous cell carcinoma
patients involved multimodality therapy. Kaplan–Meier survival curves show a worse
prognosis in terms of disease-specific survival for patients with higher-staged PSS
tumors. This did not reach statistical significance. The PSS may provide additional
prognostic information on advanced cutaneous malignancies of the temporal bone over
the more widely used AJCC staging system. However, further prospective multicenter
studies with larger sample size are required to validate our findings. Basal cell
carcinoma was well controlled with WLE/LTBR alone without adjuvant therapy, whereas
squamous cell carcinoma required multimodality therapy: WLE/LTBR and postoperative
radiation with or without chemotherapy.
KEYWORDS
Pittsburgh staging system - periauricular cutaneous malignancy - temporal bone
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James LinM.D.
LSU Health Sciences Center, 533 Bolivar Street
Suite 566, New Orleans, LA 70112
Email: jlin@lsuhsc.edu