Dermatologica Sinica

: 2021  |  Volume : 39  |  Issue : 4  |  Page : 220--221

Squamous cell carcinoma of the auricle treated by intra-arterial infusion chemotherapy

Yen-Ting Sheen1, Yi-Shuan Sheen2, Yu-Yuan Chen3, Maw-Chang Sheen4, Ming-Hsien Lin5,  
1 Division of Plastic Surgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
2 Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
3 Department of Surgery, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
4 Department of Surgery, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
5 Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan

Correspondence Address:
Dr. Ming-Hsien Lin
Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu

How to cite this article:
Sheen YT, Sheen YS, Chen YY, Sheen MC, Lin MH. Squamous cell carcinoma of the auricle treated by intra-arterial infusion chemotherapy.Dermatol Sin 2021;39:220-221

How to cite this URL:
Sheen YT, Sheen YS, Chen YY, Sheen MC, Lin MH. Squamous cell carcinoma of the auricle treated by intra-arterial infusion chemotherapy. Dermatol Sin [serial online] 2021 [cited 2022 Sep 29 ];39:220-221
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Full Text

Dear Editor,

Squamous cell carcinoma (SCC) of the external auditory canal, external ear, or periauricular skin poses special challenges for definitive surgical resection and reconstruction, as the lesion may invade the lateral skull base, or infiltrate the facial nerve, compromise hearing, and metastasize to nodal basins in the parotic and neck.[1],[2] In this paper, we present a case of SCC of the auricle that was treated by intra-arterial (IA) chemotherapy.

An 81-year-old male exhibited an unhealing ulcer on the left ear for ½ a year. The biopsy revealed moderately differentiated SCC. He refused surgical resection because of cosmetic concerns and medical comorbidities. On admission, an ill-defined, red scaly plaque over the antihelix and concha and a 1-cm ulcer on the cymba concha over the left ear was found [Figure 1]a and [Figure 1]b. No regional lymph node was palpable. Systemic evaluation, including chest X-ray, head and neck computed tomography scan, and abdominal echo all revealed no evidence of distant metastasis.{Figure 1}

The implantable port-catheter system (Jet Port Plus Allround, PFM, Cologne Germany) was used for catheterization.[3] Due to severe atherosclerosis of the superior thyroid artery, the catheter was catheterized through the left lingual artery into the external carotid artery, with the tip located proximal to the branching of the posterior auricular artery [Figure 1]c. The patient was infused continuously with 50 mg methotrexate (MTX) every 24 h using a portable pump (CADD-1, Deltec, St. Paul, Minn) with simultaneous leucovorin 15 mg intramuscular injection every 12 h. The ear pinna showed local heat, erythema, and swelling after 1 week of treatment. In total, MTX infusion was given for 12 days and was stopped due to thrombocytopenia (Grade II) and transient elevation of liver enzymes (Grade II). After continuous infusion, the tumor shrank, leaving an ulcerative wound. The patient then received weekly intermittent IA infusion of 50 mg MTX every 1 or 2 weeks at an outpatient clinic. The wound healed completely 5 months after the treatment's start. Fourteen months after the treatment, a 1-mm ulcer developed, and biopsy revealed the recurrence of SCC. Another course of continuous infusion of MTX and simultaneous leucovorin were given to the patient for 8 days and stopped due to thrombocytopenia (Grade III). The ulcer healed 1 month after treatment. The patient was carefully followed with weekly IA infusions of MTX 50 mg for ½ a year. The infusion was given every 2 weeks for 3 months, then every 3 weeks for another 3 months. No catheter-related neurological or vascular complication was noted. The patient was in sustained complete remission 7 years after recurrence.

Invasive SCC of the ear frequently follows an aggressive clinical course with a high recurrence rate, metastasis, and morbidity.[2] Traditional management of SCC of the ear consists of surgical resection, posing unique esthetic challenges for skin graft or local flap reconstruction after excision.[1],[2] Postoperative radiotherapy is performed to treat more aggressive tumors or for close surgical margins, perineural spread, or lymphovascular invasion.[1] Chemotherapy is typically reserved for metastatic disease.[1] IA chemotherapy has the potential to be more efficacious and tolerable compared with systemic chemotherapy due to higher local drug concentration and reduced systemic side effects.[3],[4] Exposure of the cochlea to cisplatin chemotherapy and radiotherapy is associated with hearing loss in patients with head-and-neck cancer.[5] IA chemotherapy with MTX and leucovorin rescue was provided for this patient, because of the high therapeutic concentration of MTX in the ear with relative lack of ototoxicity, myelosuppression, and mucositis, when compared to conventional chemotherapeutic agents.[3],[4],[5] IA chemotherapy was technically feasible and rarely leads to cerebrovascular accidents in the treatment of head-and-neck cancer.[4],[6],[7] The systemic side effects were mild and tolerable.[4],[6],[7] However, swelling, heat, and redness in the ear pinna after infusion were noted, which recovered completely 2 weeks later.

IA infusion chemotherapy combined with radiotherapy has been reported as an effective treatment for carcinoma of the ear.[8] This case report showed that IA infusion alone is also effective, with the advantage of cosmetic and functional preservation. IA chemotherapy represents an alternative option for elderly patients with comorbidities ineligible for radical surgery, radiotherapy, or systemic chemotherapy.

Declaration of patient consent

The authors certify that they have obtained appropriate patient consent form. In the form, the patient has given his consent for the images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This work was supported by grants from the National Taiwan University Hospital (NTUH 100-S4843, NTUH 111-S0233, NTUH 111-UN0028), and National Taiwan University Hospital Hsin-Chu Branch (110-HCH039).

Conflicts of interest

There are no conflicts of interest.


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