Treatment for cancer of the outer ear

• How your doctor decides on treatment for ear cancer
• Surgery
• Radiotherapy
• Follow up

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

We have a separate page about ear cancer which tells you about the different types of ear cancer and the tests you have to diagnose and stage cancer of the ear.

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. The tissue is examined 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 join the skin back together again.

Other types of surgery for cancer of the ear include

• Mohs surgery
• Wide local excision
• Lymph node surgery
• Removal of the whole ear with reconstruction

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 two 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 this may need to be removed but you should still be able to hear after the operation.

Radiotherapy uses high energy waves to treat cancer. Radiotherapy may be the only treatment you need if your cancer on the outer flap of the 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 daily for between 2 and 4 weeks. You have treatment every day from Monday to Friday. At your first appointment your radiotherapist 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.

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.