Role of the otologist/neurotologist in managing auricular and periauricular cutaneous malignancies: A 10-year otologic oncology experience.

OBJECTIVE: Auricular/periauricular cutaneous malignancies can be challenging to manage surgically due to the complex anatomy of the region. Otologists/neurotologists have unique skillsets that are well-suited to surgically treat these patients. We aim to highlight the role of otologists and neurotologists in providing surgical care of patients with auricular and periauricular malignancies by describing the experience of a single fellowship-trained neurotologist over a 10-year period.

METHODS: Retrospective chart review of 387 patients with auricular and periauricular malignancy treated by a single neurotologist between 2012 and 2022 was completed. Tumor histology and procedures performed for each patient were extracted. Additional data was collected for a subset of 84 patients with complex cases requiring selective neck dissection, parotidectomy, lateral temporal bone resection, regional advancement or rotational flap reconstruction, and/or free tissue transfer reconstruction.

RESULTS: Within the series of 387 patients, squamous cell carcinoma was the most common histology (42.6%, n  = 165), followed by basal cell carcinoma (40.8%, n  = 158), and melanoma (9.8%, n  = 38). Common surgical procedures included wide local excision (61.8%, n  = 239), partial/sub-total auriculectomy 18.3% ( n  = 71), or total auriculectomy 5.2% ( n  = 20). Within the 84-patient subset, median age at diagnosis was 71.9 years. Dermatologists provided most patient referrals (50.0%, n  = 42). Most common tumor locations included: auricular (58.3%, n  = 49), pre-auricular (21.4%, n  = 18), and parotid (27.4%, n  = 23). Revision surgery occurred in 22.6% of cases ( n  = 19), of which 26.3% ( n  = 5) for positive margins and 31.6% ( n  = 6) for recurrence. Mean follow-up was 22.8 months. Disease-specific 5-year survival was 91%.

CONCLUSIONS: We demonstrate the feasibility of an otologist/neurotologist incorporating the surgical management of auricular and periauricular malignancies into their practice.

LEVEL OF EVIDENCE: 4.