Squamous Cell Carcinoma Management in Temporal Bone and Auditory Canal

Squamous cell carcinoma (SCC) arising in the temporal bone and external auditory canal constitutes a rare and aggressive subset of head and neck malignancies. It accounts for less than 1% of all head and neck cancers yet poses a disproportionate burden owing to its insidious presentation, intricate local anatomy and high propensity for local invasion and recurrence. Tumours often present with chronic otorrhoea, otalgia or conductive hearing loss, delaying diagnosis until advanced stages. Imaging modalities such as high-resolution computed tomography and magnetic resonance imaging are essential to delineate bony erosion, perineural spread and vascular involvement. Management is principally surgical, with lateral, subtotal or total temporal bone resection determined by tumour extent, often combined with parotidectomy and selective neck dissection to address regional nodal risk. Achieving negative margins is paramount to reduce recurrence, while postoperative radiotherapy—sometimes with concomitant chemotherapy—is deployed in locally advanced or margin-positive cases. Reconstruction of lateral skull base defects employs microsurgical free tissue transfer to restore both form and function. Prognosis is closely linked to tumour stage, margin status and anatomical invasion of critical structures such as the facial nerve, ossicles or dural sinuses. Multidisciplinary collaboration across otolaryngology, neurosurgery, radiology and medical oncology underpins optimal outcomes and underscores the global imperative for standardised staging and management protocols that enhance survival and quality of life.

Research from Nature Portfolio

Recent studies have introduced robust preclinical models and refined surgical algorithms through molecular insight. A newly established cell line derived from external auditory canal SCC has been genetically characterised, identifying TP53 and NOTCH1 mutations and demonstrating positivity for both cytokeratin and cancer stem cell markers. This model forms tumours in temporal bone xenografts and reveals enrichment of inflammation and cell adhesion pathways, offering novel targets for therapeutic intervention. In parallel, detailed histopathological analysis of parotid involvement has led to evidence-based guidelines for tailored parotidectomy: elective omission of parotidectomy in early-stage squamous cell lesions and total parotidectomy in advanced disease achieve effective tumour control with reduced morbidity. These advances illustrate the synergy between molecular profiling and surgical decision-making in personalising care for these challenging carcinomas.

Squamous Cell Carcinoma Management in Temporal Bone and Auditory Canal publication trend

The graph below shows the total number of articles in squamous cell carcinoma management in temporal bone and auditory canal across all publications each year (not limited to Nature Index journals).

Technical terms

Lateral temporal bone resection: Surgical removal of the external auditory canal and adjacent temporal bone segments to excise carcinoma.

En bloc resection: Single-piece excision of tumour and surrounding tissues to achieve clear surgical margins.

Perineural invasion: Tumour spread along nerve sheaths, indicating aggressive behaviour and a higher risk of recurrence.

Free tissue transfer: Microsurgical transplantation of donor tissue, such as an anterolateral thigh flap, to reconstruct lateral skull base defects.

Negative margin: A surgical border free of tumour cells, essential for minimising residual disease and recurrence.

References

1. Carcinomas of the external auditory canal: Management and results: A multicenter REFCOR propensity score matching study. European Journal of Cancer (2024).
2. Impact of Positive-Margin Resection of External Auditory Canal Squamous Cell Carcinoma. Cancers (2023).
3. Biological and genetic characterization of a newly established human external auditory canal carcinoma cell line, SCEACono2. Scientific Reports (2023).
4. Management of lateral skull base cancer: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology and Otology (2016).
5. Squamous cell cancer of the temporal bone: a review of the literature. European Archives of Oto-Rhino-Laryngology (2020).
6. Evidence Based Tailored Parotidectomy in Treating External Auditory Canal Carcinoma. Scientific Reports (2018).
7. Prognostic Impact of Tumor Extension in Patients With Advanced Temporal Bone Squamous Cell Carcinoma. Frontiers in Oncology (2020).
8. Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection. European Archives of Oto-Rhino-Laryngology (2019).
9. Radiological Findings of Malignant Tumors of External Auditory Canal. Medicine (2015).