Infiltrative Bcc on my Ear?

Question

I had a lump on my left ear removed with curettage (full excision) sent for biopsy. The results shows it was an 'infiltrative' basal cell carcinoma. When I spoke to my dermatologist about the results he said that he couldn't be sure they had got it all out, that 'infiltrative' is a more aggressive type of basal cell. He said it was up to me whether I want to have my ear opened up to see if any cancer remains? He said it might not be worth it as they might have got it all? Any advice?

Raffy Karamanoukian, MD, FACS · Answer

Complete excision with negative margins remains the gold standard for skin cancer cure. It is up to you, knowing the full risks and having informed consent, whether you desire to withold further treatment. In my office, I would recommend curative cancer surgery, if possible.

Dina D. Strachan, MD · Answer

Infiltrative BCC is more difficult to remove. Mohs surgery would be the best choice for treatment. Mohs is done in stages. When Mohs is done the surgeon can check to see if the margins are positive before closing the wound. If need be, another section is excised. It also helps prevent removal of extra tissue when there is no cancer which can be important in areas with little excess skin, such as on the ear. Make sure you are treated by a certifed Mohs surgeon. Good luck.

Karen Nern, MD · Answer

Infiltrative basal cell carcinomas can have small roots that can go much deeper than can be seen with the eye. Curettage frequently cannot treat these roots because the normal collagen surrounding them blocks the curette from being effective. Mohs surgery is the surgical equivalent to taking the bad spot out of an apple. The cancer containing skin is removed and then the edges are evaluated to see if any cancer remains (like looking at the underside of the piece of apple that was removed to see if there is any brown at the edges). If cancer is still at the edge, the surgeon goes back to the exact spot where the cancer still is and takes more until it is gone. You can find an experienced Mohs surgeon through the Mohs College or the American Society for Mohs Surgery.

Curtis Wong, MD · Answer

should probably be further managed unless you equate curettage to an actual excision where the cartilage was removed completely and the edges cut with a blade instead of scraping (which is what curettage is). You can consider Mohs or frozen sections to help ensure margins are clear and if the defect is small enough, a menu of options for closing it or allowing it to heal is available. You have a BCC, the most benign of skin cancers so if you were my patient, if there was no obvious evidence of persistence, you could choose to observe it closely as recurrences will be local. You could consider radiation therapy but we tend to avoid it if at all possible due to long term changes from radiation. If you had a true excision and margins are microscopic at best, risks of a recurrence are less that 50%. You would have to decide if it was worth pursuing further.

Tom J. Pousti, MD · Answer

I think that you will do best by seeking a Mohs surgeon who can  remove the residual  (if any) basal cell carcinoma present. This procedure is performed by  incrementally removing segments of skin until the carcinoma is no longer visible on microscopically  examined specimens.  

	On the one hand, this technique allows for excision of residual carcinoma ( and its branch like tentacles);  on the other hand, the resulting defect/wound is kept as small as possible.  Additional reconstructive surgery may be necessary to repair/close this defect/wound.

	 I hope this helps.

Gary R. Culbertson, MD · Answer

Infiltrative BCCA can be a bad actor and is usually not treated with just curettage. This type of BCCA can grow like crab grass and is best removed by Moh’s Surgery. Moh’s Surgery is a serial circumferential excision around a skin tumor often resulting in a rather large defect. The procedure was developed by a General Surgeon named Dr. Moh. It works very well in the elimination of certain skin cancers that have high recurrence rates like infiltrative BCCA. May I suggest you seek out a Moh’s surgeon in your area. They will create the defect and then, often send you a another surgeon for reconstruction. Best,

	 

	 

	Gary R Culbertson, MD, FACS

Infiltrative Bcc on my Ear?

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