The Ears, A High Risk Area for Skin Cancer

Kelley Pagliai Redbord, MD,
and C. William Hanke, MD

Incidence of skin cancers: The numbers are daunting. One in every five Americans is diagnosed with skin cancer - the most common form of cancer in the United States. The American Cancer Society estimates that 1.3 million new cases of nonmelanoma skin cancer, which include basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), will be diagnosed this year. One in every 62 Americans will develop melanoma and about 8,000 are expected to die from the disease this year.* These numbers leave us asking one question: How do we begin to reduce this troubling and dangerous trend? The answer lies in the cause and at least in part, on your ears.

Incidence of Skin Cancer on the Ear

ears_figure1

Figure 1. The surface anatomy of the external ear (auricle) is complex. Top is a front view and bottom is a back view.

In a recent study of 2,785 patients, the ears were the third most frequent location for basal cell carcinomas. Of the 269 ear basal cell carcinomas, 39% (105) were located at the preauricular crest (in front of ear), 36.5% (99) on the posterior auricle (back of ear), and 24.2% (65) on the helix (rim) of the ear.

The ears were the third most frequent location for basal cell carcinomas.

In order to better assess skin cancer on the ears, we examined 102 patients with 113 skin cancers on the ears, documented the precise location of the cancer on the ear, the type of cancer and the sex of the patient.

We found that skin cancers can occur on any part of the ear including the bowl, an area that is relatively protected from the sun. Figure 1 shows the complex and intricate anatomy of the ear. The number of skin cancers that developed on each anatomic site on the ear is shown in Figure 2. The anterior superior rim was the most common location (n=30) followed by the bowl (n= 18) and back of ear (n= 18).

In our series of 113 skin cancers, we documented 65 basal cell carcinomas, 45 squamous cell carcinomas, one melanoma and two rare skin cancers (malignant fibrous histiocytoma and atypical fibroxanthoma).

Who Is Most at Risk?

Of 102 patients with ear cancers, 88
were men and only 14 were women.

Exposure to the sun's ultraviolet (UV) rays is the major risk factor for the development of skin cancer. More than 90% of all skin cancers are caused by UV radiation. While skin cancer can occur anywhere on the body, it most commonly occurs on sun-exposed areas such as the ears where sunscreen is often not applied at all.

ears_figure2
Figure 2. The numbers in the circles indicate the number of skin cancers that were found on each part of the ear in a study of 113 skin cancers.

Skin cancer on the ears was more prevalent in men than women. In our study, 102 patients presented with skin cancers on their ears: 88 were men as opposed to only 14 women. Another recent study examined 656 squamous cell carcinomas. A great number of squamous cell carcinomas were located on the ears of men, but no squamous cell carcinomas were found on the ears of women. This is likely due to improper sunscreen application and shorter hairstyles in men. Women are not immune, especially if they have fair skin, thin or short hair, or wear their hair up.

How to Prevent Skin Cancer on the Ear

ears_figure3_bcc
Figure 3. Basal cell carcinoma
involving the ear.

Fewer than 33% of people routinely use sunscreen and sun protection. However, the public is becoming more and more aware that the use of broad-spectrum sunscreens and sun-protective practices can prevent skin cancer. Recognition of the benefits of broad-spectrum sunscreen with a high SPF that is effective against both UVA (ultraviolet A) and UVB (ultraviolet B) rays is increasing. The key to decreasing skin cancer will be thorough sunscreen application and sun protection. Despite the fact that about one ounce of sunscreen is required to cover the entire body, most people apply only a quarter to a half of that amount. If the sunscreen is not properly applied - especially in hard-to-reach areas such as the ears - the benefits of application will be completely lost.

Only one of three people
routinely use sunscreen.

The ear is a complex structure with many anatomic grooves, ridges, rims and crevices. One must pay special attention and take extra time to apply sunscreen to all areas of the ear.

We are becoming more aware of the enormous benefits of sunscreen use. It is essential to apply sunscreen liberally and remember the areas that are too often forgotten, such as the ears. Your elbow is not the only safe thing to put in your ear anymore - try sunscreen.

Kelley Pagliai Redbord, MD, is completing a Procedural Dermatology Fellowship Training Program, under the direction of. C. William Hanke, MD, and Dr. Hanke is incoming President-Elect of the American Academy of Dermatology, Director, Laser and Skin Surgery Center of Indiana, Carmel, IN, and a Vice President of The Skin Cancer Foundation, New York, NY.

From The Skin Cancer Foundation Journal, Vol. 25, 2007

*For the most up-to-date statistics, please see our Skin Cancer Facts.