Abstract

Background: Ear has been associated with aggressive cutaneous squamous cell carcinoma (CSCC) because of its location. Our purpose is to evaluate CSSS in the ear versus non-ear head and neck (NEHN) sites. Methods: After IRB approval, 57 patients of CSSS of the head and neck were recruited from the archive of pathology department from 2011 to 2020. Data and analysis were performed on two cohorts (ear, n=30 vs NEHN, n=27). Results: NEHN histology revealed only statistically significant lymphovascular invasion (30% NEHN vs 10% ear, p-value = 0.05) and desmoplasia (67% NEHN vs 20% ear, p-value = 0.001).  Ear carcinomas had more negative margin (50% ear vs 33% in NEHN, p-value = 0.03) and had less recurrence (no recurrence in the ear vs 22% recurrence in NEHN, p-value = 0.006). There was no difference in T stage, depth of invasion or tumor size.  Ear vs NEHN did not affect progression free survival or overall survival. Conclusion: The location of ear renders it more likely to have negative margins since it is easier to excise, also resulting in less recurrence. Also, as landmark studies have compared ear to the rest of the body, as opposed to other head and neck sites as in this study, ear may seem to have less aggressive features with no effect on prognosis. It raises a question of whether most head and neck sites should be considered high-risk, because of its sensitive location. Our data necessitates further studies refining the tumor’s location as a high-risk criterion.