Radiotherapy of carcinomas of the skin overlying the cartilages of the nose and ear.

Abstract

Carcinomas of the cutaneous covering of the cartilaginous portions of the nose and pinna justify special consideration as a separate group from the standpoint of treatment. These carcinomas grow on parts of the facial anatomy which decisively influence the physiognomy of the patient. The skin overlying the nose and pinna is for the most part of very limited elasticity and is intimately attached to the underlying cartilage. These circumstances, except in very early superficial lesions, defy the possibility of wide surgical excision without resulting deformity or need for cosmetic repair. When properly administered, roentgen therapy offers excellent opportunity for cure and, in addition, the best possible esthetic results. It needs to be employed skillfully, however, in order to avoid the dreaded complication of chondronecrosis; but necrosis of the cartilage may result also from neglect of the superficial reactions and their secondary infection. Carcinomas of the skin of the nose and external ear occur rather frequently: those of the nose make up approximately 25 per cent and those of the ear about 8 per cent of all carcinomas of the skin of the face. Basal-cell carcinomas predominate in the nose, especially in the ala nasi, whereas squamous-cell carcinomas comprise most of the neoplasms on the pinna, particularly in the helix and antihelix. Regardless of their histologic character, malignant tumors of the skin of the nose and ears may extend to the cartilage and may become infected, forming an excavating ulcer and a permanent defect. Squamous-cell carcinomas of the nose may metastasize to submaxillary lymph nodes and those of the pinna to the preauricular nodes and to the upper cervical region; squamous-cell carcinomas of the ear are among the most highly metastasizing of all squamous-cell tumors of the skin. When metastases occur, they appear, as a rule, within a period of two years after the primary lesion. Treatment A variety of procedures have been and continue to be applied in the treatment of carcinomas overlying the cartilages of the nose and ear. Among them is the application of caustic pastes and acids, which usually result in considerable scarring and painful chrondronecrosis. Cautery and electrocoagulation may have similar consequences unless done superficially or in limited areas. At best, the procedures may succeed in controlling the tumor but at the price of a lesser esthetic result. Surgery: Surgery is perhaps the most widely applied treatment for small tumors in the areas under consideration. A simple excision may be possible for small, superficial lesions; this is an expeditious treatment, which should be followed by adequate microscopic examination of the specimen to assure the surgeon of the adequacy of the removal. Larger lesions require a skin graft because of the impossibility of bringing the borders of the wound together.