Cancer of the Outer Ear

Ear cancer is rare. Most often, it begins in the skin of the outer ear. Out of 100 skin cancers that develop, approximately 5 occur in or around the ear. In the United States, about 200 patients are diagnosed annually for cancer related to the ear and temporal bone.

Anatomy of Outer Ear

The ear comprises of the outer, middle and inner ear. The ear we see is the outer ear and it protects the more internal parts of the ear. Furthermore, it aids in collecting sound waves.

The outer ear comprises of the pinna or ear flap, meatus or ear canal, and tympanic membrane or eardrum. When the ear receives sound waves, they travel to the eardrum where vibration occurs.

The temporal bone is also an important component of the ear. It surrounds and protects the inner ear, middle ear, and the ear canal. The temporal bone has 5 parts: mastoid, squamous , tympanic, petrous and styloid.

The outer ear is connected to the middle ear by a tube called the external auditory canal. The outer ear and the middle ear are divided by the tympanic membrane.

Types of Outer Ear Cancers

Three types of cancers are associated with the outer ear:

1. Basal skin carcinoma (BCC)
2. Squamous cell carcinoma (SCC)
3. Melanoma

Basal cell carcinoma (BCC)

Usually this type of cancer is seen on the skin areas that are exposed to the sun, for example, the face, nose, scalp, forehead and neck. During the early stages, it may not cause pain. When the affected individual has a minor injury, bleeding can be noticed. However, it may heal, but this can be prolonged over a period of months, with no visual clues. About 15% of BCC occurs in the external auditory canal. The sclerosing subtype is the most common form of BCC.
Here are the 5 warning signs:

1. A common symptom of the initial stages of BCC is an open sore that is not healing. The sore will ooze out and crusts will continue to remain open for a couple of weeks, and even if the sore heals, it will bleed constantly.
2. In the chest, arms, face, legs or shoulders, patients will notice an irritated area or a red colored patch. The patch may crust over and create an itching sensation or in cases even be asymptomatic.
3. There may be a bump that looks shiny or like a pearly nodule in white, red, or pink color, or simply clear. The bump could be black, tan, or brown. In people with dark skin tone, it can look like a normal mole.
4. A pink colored growth with a slightly elevated border, which is rolled over with a crusted indentation in the center, may be visible. Small blood vessels will develop on the skin surface when the growth is enlarged.
5. An area resembling a scar that is yellow, waxy or white in color, with borders that are poorly defined, may be present. The skin may appear taut and shiny, which is indicative that the BCC is invasive and like an iceberg (i.e. larger on the inside than its outer appearance on the surface of the skin).

Squamous Cell Carcinomas

Squamous cell cancer, in most cases, tends to arise from a precancerous lesion, an actinic keratosis. It is a flat, rough, crusty spot of skin, and it is also called a solar keratosis. The lesion will appear to be raised on the surface of the skin as it malignantly evolves anywhere on the outer ear. When touched, the lesion will be firm.

In some cases, the color of the lesion will be slightly changed when compared to the normal skin. The lesion will be similar to that of a wart that crusts and also bleeds at times. It may appear like a persistent red patch that is scaly with irregular borders. The sore will remain open, crust over and bleed for many weeks. Elevated growth is visible and a depression is visible in the center, which bleeds occasionally. It can grow quickly.

When compared with BCC, squamous cell carcinomas are more aggressive types of skin cancer. If left untreated, the skin layers will be pushed to the nerve roots and create pain and signs of chronic illness. Both BCC and SCC belong to non-melanoma types of skin cancer. SCC can relapse; thus, aggressive therapy is recommended.

Melanoma

Melanoma is mostly caused by exposure to ultraviolet rays from the sun. Often melanomas are mole-like, and in some cases melanomas develop from moles. It is the most aggressive form of skin cancer and may appear red, pink, blue, white, purple, brown or black in color.

Lentigo maligna is a type of non-invasive melanoma that is mostly found in damaged skin of the ear or face. Invasive types are known as lentigo maligna melanoma. The year 2016 has seen about 76,380 melanoma cases of the invasive type. The most uncommon form of skin cancer, melanoma, is difficult to treat and causes the most deaths. In the US, 10,130 death cases are reported annually due to melanoma.

Further Reading

• All Cancer of the Ear Content
• Cancer of the Middle and Inner Ear
• Ear Cancer Research
• Symptoms of Ear Cancer

Written by

Dr. Damien Jonas Wilson

Dr. Damien Jonas Wilson is a medical doctor from St. Martin in the Carribean. He was awarded his Medical Degree (MD) from the University of Zagreb Teaching Hospital. His training in general medicine and surgery compliments his degree in biomolecular engineering (BASc.Eng.) from Utrecht, the Netherlands. During this degree, he completed a dissertation in the field of oncology at the Harvard Medical School/ Massachusetts General Hospital. Dr. Wilson currently works in the UK as a medical practitioner.