Diagnosis
Due to its characteristic appearance, the diagnosis of a basal cell carcinoma of the ear is usually made clinically. However, a biopsy, i.e. a small tissue sample of the affected area, is usually taken to confirm the diagnosis, which is then examined under a microscope. Photodynamic therapy (PDT) is another diagnostic option for basalioma.
PDT can be used to determine the extent of basal cell carcinoma growth in depth. For this purpose, the affected skin area is rubbed with a special cream and then irradiated with wood light. The patient’s cells, enriched with the active substance of the cream, then light up visibly.
Complications
Untreated, the basal cell carcinoma grows continuously into the depth and width of the skin. This can lead to the destruction of cartilage and bone tissue and of skin areas. In the worst case, this can lead to severe disfigurement of the face or the destruction of vital structures in the head and neck area such as nerves and vessels.
For this reason, basaliomas, even if they do not metastasize, should always be treated. A basal cell carcinoma has a low metastasis rate and can therefore infiltrate and destroy neighbouring tissue. This makes a therapy of the basal cell carcinoma necessary.
Depending on the type, size and extent of the basal cell carcinoma of the ear, as well as on the age and state of health of the person affected, there are various therapy options. Due to its curative possibilities, surgery is the gold standard. In most cases, a basal cell carcinoma can be removed quickly and easily under local anesthesia by a dermatologist.
If there are recurrences, the basal cell carcinoma is larger than 5mm, or it grows in depth, surgery is usually performed in 2 steps. First, the basal cell carcinoma is removed with a certain safety margin, then the edges of the preparation are examined for suspicious tumor cells. If there are more tumor cells, this indicates that the basal cell carcinoma has not been completely removed, which makes a second operation necessary.
In this case, further healthy tissue around the original basal cell carcinoma is removed and examined again. In most cases this can prevent recurrences, i.e. repeated basaliomas. Another form of therapy for a basal cell carcinoma is radiotherapy.
In this method, the affected skin area is irradiated with X-rays or proton radiation. This type of therapy is preferred especially for people of advanced age or poor general condition for whom surgery would be too risky; for recurrences or basaliomas that are difficult to access for surgery. This concerns especially basaliomas of the eyelids.
Radiotherapy is also preferred to surgery for cosmetic reasons in the case of basaliomas of the face. Possible side effects of radiotherapy may be a sunburn-like rash on the treated area, which can be treated well with special creams. Alternatives to radiation therapy can also be kyrotherapy (icing) or photodynamic therapy, in which special light-sensitive agents are injected into the skin and destroy diseased tumor tissue under strong light irradiation while sparing the surrounding healthy tissue.
In kyrotherapy, the basal cell carcinoma of the ear is frozen by means of liquid nitrogen. The disadvantage of this method, however, is the later occurrence of skin changes which are difficult to distinguish from a basal cell carcinoma recurrence. Another, more recent possibility to treat a basal cell carcinoma is the superficial treatment with Imiquimod.
Imiquimod is an active substance that causes the cell death of diseased tumour cells by means of a local inflammatory reaction and on the other hand stimulates the immune system, which helps to reject the tumour cells. Affected skin areas should be rubbed with Immiquimod cream five times a week for a total of 6 weeks and treated. The treated skin will then redden and form crusts, indicating the beginning of a healing process.
In 80% of cases, the skin would be healed without scarring or recurrence after 2-3 months. As this method is still very new and long-term results are lacking, recurrences cannot be excluded with certainty after many years. In the meantime, however, therapy with Imiquimod has already been approved for small superficial basal cell carcinomas in the facial area and thus represents a good alternative to surgery.
Another alternative in the treatment of a basal cell carcinoma is local chemotherapy with 5-fluorouracil in the form of a cream. Here too, the cream should be used for 4-6 weeks. The use of Vismodegib is recommended for patients with aggressively growing basal cell carcinomas, for whom neither surgery nor radiation is an option. However, the advantages of this therapy are currently still being discussed.
