The multidisciplinary management of non-melanoma conchal bowl skin cancer

Mohs micrographic surgery (MMS) has been shown to achieve high cure rates and reduce recurrence rates of skin cancer in auricular and preauricular regions. Non-melanoma skin cancers of the conchal bowl are difficult to treat due to the challenge of accessing them and their close association with surrounding structures that may be inadvertently involved. Treatment goals in this anatomical area include total tumour removal and maximal tissue conservation to provide the best functional and aesthetic result for the patient. We present two patients with conchal bowl basal cell carcinoma treated with MMS and found to have extensive disease that benefited from collaborative management with an ear, nose and throat (ENT) surgeon. Where extensive subclinical spread is encountered or complex reconstruction is required it is useful to adopt a multidisciplinary approach to achieve total tumour control and maximal tissue conservation. Currently preoperative assessment of tumour margins is difficult and limited data are available on what cases should be co-managed. Our recommendation is that collaborative ENT involvement be reserved for cases where a long history is involved, a history of recurrence, previous failed excisions, close proximity to difficult to access areas, histological subtypes of skin carcinoma that are known to be aggressive or recurrent or when there is suspicion of subclinical spread based on other grounds.