Management of the Parotid Gland in Cutaneous External Auditory Canal Skin Cancer

Abstract

Cutaneous squamous cell carcinoma of the external auditory canal is a rare tumor, presenting with nonspecific symptoms. Any nodal disease in patients with temporal bone malignancies places the patient in stage IV category within the modified Pittsburgh staging system. Management of the nodal basin for these patients remains controversial. A MEDLINE and PubMed search was performed comparing a parotidectomy with observation for patients with cutaneous malignancies of the EAC. Results of the search was largely limited to retrospective chart reviews with low quality evidence containing a limited number of patients largely secondary to the rare nature of the disease process. These articles are summarized and reviewed. Few studies directly compared observation to parotidectomy resulting in need for indirect conclusions to be made to answer the proposed question. The studies provide low quality evidence for the conditional weak recommendation of performance of an elective parotidectomy in management of malignancies of the external ear canal. Nodal disease is a negative prognostic indicator and a parotidectomy may assist with staging and prognosis, allow for obtaining soft tissue margins, and providing control of the facial nerve with limited increase in morbidity.