The importance of surgery in Temporal Bone malignancies

The importance of surgery in Temporal Bone malignancies
Mahtab Rabbani Anari, M.D.
Department of Otorhinolaryngology – Head & Neck Surgery, Imam-Khomeini Hospital
Complex, Tehran University of Medical Sciences.M_rabani@razi.tums.ac.ir

Basal cell carcinomas (BCCs) are the most common skin cancers and about 80 % of them occur in the head and neck region. Although it is extremely rare for BCCs to metastasize, occasionally, their invasive and locally destructive behaviors cause severe morbidities and resistance to standard treatment. Characteristics associated with more aggressive behavior include: size, location (the H-shaped region: mid-face, nose, eyes and ears), longstanding tumor, poorly defined borders, perineural invasion, subtype other than nodular or superficial, incomplete excision and failure of previous treatment.

The mainstay of treatment for aggressive BCC is wide surgical resection with adequate margins, with or without adjuvant radiotherapy. Therefore in advanced cases a multidisciplinary approach is needed. BCC in the temporal bone has the risk of perineural invasion and deep infiltration to skull base region.

Here, we present one of our challenging cases with BCC of retro- auricular and temporal bone involvement who needed four revision and salvage team surgeries. We try to emphasize on the importance of an adequate surgery in the high risk patients with temporal bone malignancy.