You need to be more precise, for example, detailing the size of the lesion and the exact anatomical areas of the pinna that are affected. A photo would, of course, be the best thing - make sure you have anonymized the image before uploading it.
At a simple level, my thoughts are as follows:
1) Cosmesis is not very important, esp. in a 70 year-old;
2) Wedge resection with good margins would be the easiest thing.
To add to Mr Sivathasan, In ideal world, I would suggest a proper staging if possible. However regardless, while radical surgery (with adequate free margin) is the best but not always possible in the given location. Assuming no clinical metastasis consider palliative surgery (to avoid disfigurement and reconstruction) +/- Radiotherapy option, or total Radiotherapy (if surgery is not the option).
I am agree with mr Tripathi. Radical surgery if possible. And discuss Adjuvant radiotherapy if R1 surgery. Or total radiotherapy if surgery is not possible
Excision with margins including cartilage is not difficult there. Radiotherapy would not be indicated unless poor-differentiation, peri-neural invasion or evidence of LN spread.
A photo is essential here
A trap door flap (Br J plas sur October 2013)
Is worth considering
This can cover almost the total inner aspect of the ear
Without distorting either the size or shape of ear
Perhaps you would care to look at our publication simplifying the approach to this problem (see Contributions: "Bridging phenomenon...) in Head & Neck Surgery.
Mr Regan is probably referring to an alternative solution presented in the nice publication in the JPRAS (Br J Plast Surg ceased to exist some years ago)
Excision of the cartilage as well and reconstraction with an advanced skin flap from behind the ear lobe
Well, I generally agree with everybody.
To give a more precise answer I think we would all need to know the clinical staging and have a photo to look at.
In addition, reconstructive wise, the "feel" of the surrounding tissues is of great importance and very hard to transmit in writing
The best tratment is surgical excision in local anesthesia with histological confirmation of radicality. If possible mohs'surgery
Mohs surgery is the best treatment in this case. It is tissue sparing, and the cartilage can usually be spared. If cartilage is not involved, a full thickness skin graft from the postauricular area would be a simple, cosmetically acceptable reconstruction.
Moh's surgery may not be absolutely necessary (too time consuming), the resection may include cartilage per primum and the reconstruction can be relatively simple (without flap surgery - see Head & Neck 36, 735-738,2014)
Ultimately, each case has to be evaluated seperately.
Excise it with a 6mm peripheral margin - either with or without cartilage in the base depending on macroscopic oncological clearance margins. A full examination of draining lymphatic regions is mandatory.
I agree, excise with 6mm margins under local anaesthetic +/- cartilage. You should discuss with the patient pre-operatively the options, but I agree with Brian Jiang, that in a 70yr old a full thickness graft would be a good simple option.
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