Patterns of Regional Metastasis in Advanced Stage Cutaneous Squamous Cell Carcinoma of the Auricle

Objective. To determine patterns of regional metastasis in patients with advanced stage cutaneous squamous cell carcinoma of the auricle. Study Design. Case series with chart review. Setting. University-based tertiary care hospitals. Subjects and Methods. We analyzed 41 patients with stage III and IV squamous cell carcinoma of the auricle. Results. The mean age was 74.2 years (range, 20.6-91.7 years). Thirty-five patients (85.4%) were stage IV. Twenty-nine patients (70.7%) had a prior history of nonauricular, nonmelanotic skin carcinoma. Twenty-four patients (58.5%) had regional metastasis to either the cervical or parotid nodal basin. In patients with cervical metastasis, the involvement by level was 6.7% (n = 1), 80.0% (n = 12), 46.6% (n = 7), 13.3% (n = 2), and 40.0% (n = 6), respectively. Of the 6 patients with a level 5 metastasis, 3 had primaries in the preauricular region, 2 had primaries of the auricle, and 1 had a primary of the postauricular region. Occult disease was present in 2 patients (9.1%) with cervical metastasis and in 4 patients (18.2%) with periparotid lymph node metastasis. Perineural invasion was seen in 84.4% of the study population. The recurrence rate was 46.3% (n = 19). The median time to recurrence was 28.3 months. Conclusion. Patients with advanced stage auricular cutaneous squamous cell carcinoma have a high rate of regional metastasis and recurrence. When planning neck dissections for these patients, level 5 should be included in the resection. Patients demonstrating locally advanced disease without clinical or radiographic evidence of metastasis to the parotid or cervical drainage basin should undergo a parotidectomy and comprehensive neck dissection.