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Cancer of the outer ear

This page tells you about cancer of the outer ear (the pinna). There is a separate page about cancer of the ear canal or middle ear. There is information on this page about

 

The ear

There are 3 parts to the ear

  • The outer ear
  • The middle 
  • The inner ear

Another important part of the ear is the bone that surrounds and protects the ear.

The outer ear is the part of the ear we can see. It protects the rest of the ear and helps us collect sound. There are 3 parts to the outer ear

  • The ear flap or pinna
  • The ear canal (meatus)
  • The eardrum (tympanic membrane)

The eardrum vibrates when a sound is made.

Outer ear

 

The bone

The bone that surrounds the ear is called the temporal bone. The ear canal, middle ear and inner ear are all within the temporal bone. The temporal bone is part of the skull above the ear.

One part of the temporal bone is called the mastoid bone. It is the lumpy bit you can feel behind your ear. The outside of the mastoid bone is a hard solid bone but inside is bone that is shaped like honeycomb. There is air inside the small cavities. They also contain the inner ear and the nerves that control the movement of the face and tongue.

Temporal bone

 

About cancer of the outer ear

Cancer of the ear is a rare cancer. Most of these cancers start in the skin of the outer ear. About 5 out of 100 skin cancers develop on the ear. Those that develop inside the ear are very rare. Less than 1 in every million people in the UK will develop cancer in the middle ear each year.

The most common type of ear cancer is squamous cell cancer. Other types include 

  • Basal cell cancer
  • Melanoma
 

Tests for ear cancer

Your doctor will examine you and you may have blood tests to check your general health.

The only way to confirm a diagnosis of cancer is to take a small amount of tissue from the abnormal area of the ear and examine it under a microscope. Doctors call this a biopsy. Before your doctor takes the biopsy they give you a local anaesthetic to numb the area so you don’t have any pain.

If the biopsy shows a cancer, you may also have an MRI scan or a CT scan to help your doctor decide which treatment you need. Not everyone needs these scans. There is more information about these scans in the cancer tests section

 

Symptoms of cancer of the outer ear

The main symptom is a spot or sore that doesn’t heal within 4 weeks. Most squamous cell cancers are pink lumps that have a hard scaly surface. They often bleed easily and ulcerate. If you have mole on your ear you should report any changes, such as the mole growing, itching or bleeding.

 

Stages of cancer of the outer ear

The staging of a cancer looks at the size of the cancer and whether it has spread. The staging system for cancers of the outer ear is the same as for skin cancer. You can read more about this on our stages of skin cancer page in the skin cancer section. If you have a melanoma, the staging system is the same as for melanomas that develop elsewhere on the body. You can read more about this staging system on the stages of melanoma page.

 

How your doctor decides on treatment for ear cancer

Surgery and radiotherapy are the main treatments for cancers that start on the outer ear. These treatments cure most cancers of the outer ear.

The treatment you have for cancer of the ear depends on

  • Where in the ear the cancer is
  • The type of cancer you have
  • The size of the tumour
  • Whether it has spread beyond the area it started in (the stage)
  • Your general health
 

Surgery

The type and amount of surgery you have depends on the stage of your cancer.

The most common type of surgery is excision biopsy. The surgeon removes the cancer and a border of healthy tissue all around it. A pathologist looks at the tissue under a microscope. If there are any cancer cells in the border you may need to have further surgery. Removing a border of healthy tissue around the cancer helps to lower the risk of the cancer coming back. There is more information about this in the surgery for skin cancer section.

If your cancer is small your surgeon will remove the cancer and the clear margin of tissue from around it, and then join the skin back together again.

Other types of surgery for cancer of the ear include

Mohs surgery

Mohs micrographic surgery (MMS) is a specialist technique where the surgeon removes a little tissue at a time. The tissue that is removed is checked in the laboratory while you have the operation. This type of surgery helps you to keep as much healthy tissue as possible. You can read more about Mohs surgery in the skin cancer section.

Wide local excision

You may have a wide local excision if your cancer was not completely removed when you had the biopsy. A larger area of the skin and tissue of the ear is removed. If a very large area needs to be removed you may need to have a skin graft or flap. This is when your surgeon takes skin or tissue from another part of your body to repair the area. There is detailed information about skin grafting in the surgery for skin cancer section.

Lymph node surgery

If your lymph nodes are swollen your surgeon will remove them in an operation called lymph node dissection. You may also need to have one of your salivary glands removed. Your mouth may feel drier after this. But there are a number of salivary glands in your mouth so you will still make some saliva.

Removal of the whole ear with reconstruction

This is a very rare operation. You surgeon would only suggest it if your cancer is affecting most of your outer ear. If you need to have the whole of your outer ear removed, your surgeon may be able to rebuild (reconstruct) your ear. This surgery is only carried out by specialist surgeons.

Surgeons can reconstruct either by using living tissue or using a false (prosthetic) ear. The false ear is made of flesh coloured hard rubber (silicone).

There are pros and cons to both types of surgery. Your specialist surgeon will talk to you about the best operation for you. Making an ear out of living tissue is a complicated and long procedure and needs at least 2 operations. The silicone ear is a less complicated operation, but the ear is removable. The surgeon puts pins in the bone behind your ear and you attach the prosthetic ear to those. It is not permanently fixed and you have to remove it daily to clean it. If your ear is knocked it can become unclipped from the pins that hold it in place. Also the colour of the silicone may change in time, so that it doesn’t match your skin. Most people need to have a new silicone ear about every 18 months.

Your hearing should not be affected because the middle ear is not removed. If the cancer has grown into the ear canal your surgeon may need to remove this, but you should still be able to hear after the operation.

 

Radiotherapy

Radiotherapy uses high energy rays to treat cancer. Radiotherapy may be the only treatment you need if the cancer on the outer flap of your ear (the pinna) is small.

If you have surgery, you may need radiotherapy afterwards, if your surgeon cannot remove a border of healthy tissue from around the cancer. The radiotherapy lowers the chance of the cancer coming back after the surgery.

You have radiotherapy for between 4 and 6 weeks. You have treatment every day from Monday to Friday. At your first appointment your radiotherapy doctor (clinical oncologist) plans your treatment. The planning appointment takes a couple of hours but after that the treatments only take a few minutes.

The side effects of radiotherapy include

  • Reddening of the skin of the ear
  • Sore and tender ear
  • Swelling around the ear

You may need to take antibiotics if your ear becomes hot and you feel feverish. Rarely, the ear can become sore some time after treatment has finished. If your ear changes colour or becomes sore tell your doctor as soon as possible. You may need antibiotics and steroids to stop further problems.

You can find more information about radiotherapy in our cancer treatment section.

 

Follow up

You will have regular check ups once your treatment has finished. Your doctor will examine your ear and ask about your general health. You can ask any questions you have and tell your doctor if anything is worrying you. How often you have check ups depends on your situation. They usually start off every 2 or 3 months and gradually become less often.

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Updated: 31 July 2014