Treatment for cancer of the outer ear
You might have surgery or radiotherapy, or a combination of both to treat cancer of the outer ear.
This page is about treatment for cancer that starts in the skin flap of your outer ear. Although the ear canal is part of the outer ear, its treatment is different.
You can read about treatment for cancer that starts in the ear canal on the pages about cancer of the ear canal, middle ear and inner ear.
Treatment decisions
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
The treatment you have depends on:
- where in the ear the cancer is
- the type of cancer you have
- the size of the tumour
- whether it's spread beyond the area it started in (the stage)
- your general health
Surgery
The type and amount of surgery you have depends on the stage of your cancer. Your specialist nurse and surgeon will tell you about your surgery and the possible side effects. They will also talk to you about how you will look afterwards and how you might feel.
Excision biopsy
This is the most common type of surgery for cancer of the outer ear. The surgeon removes your cancer and a border of healthy tissue around it. A pathologist looks at the tissue under a microscope.
You might need to have further surgery if cancer cells are found in the border of tissue. Removing a border of healthy tissue around the cancer helps to lower the risk of the cancer coming back.
Mohs surgery
Mohs micrographic surgery is a specialist technique.
The doctor removes a little cancer tissue and it is immediately examined under a microscope. They only remove more tissue (and examine it) if the tissue contains cancer cells.
The surgeon continues in this way until they have removed all of the cancer. The aim is to keep as much healthy skin as possible.
Wide local excision
You might have a wide local excision if your cancer wasn't completely removed when you had the biopsy. A larger area of the skin and tissue of the ear is removed.
You might need to have a skin graft or flap if a very large area is involved. This is when your surgeon takes skin or tissue from another part of your body to repair the area.
Lymph node and salivary gland surgery
Your surgeon might remove nearby lymph nodes if your lymph nodes are swollen.
You might also need to have one of your salivary glands removed. Your mouth might 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. Your surgeon will only suggest it if your cancer is affecting most of your outer ear. Your surgeon might be able to rebuild (reconstruct) your ear. This is only carried out by specialist surgeons.
Surgeons carry out a reconstruction either by using living tissue or using a false (prosthetic) ear. There are pros and cons to each type of surgery. Your specialist surgeon will talk to you about the best operation for you.
Living Tissue
Making an ear out of living tissue can be complicated and is usually a longer procedure. It needs at least 2 operations.
False ear
The false ear is made of flesh coloured hard rubber (silicone). 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. The ear can become unclipped from the pins if it is knocked. It's not permanently fixed and you have to remove it daily to clean it.
The colour of the silicone might 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 with either of these operations. This is because the middle ear is not removed. If the cancer has grown into the ear canal your surgeon may need to remove this. But you should still be able to hear after the operation.
Radiotherapy
Radiotherapy uses high energy rays to treat cancer. You might have radiotherapy:
- as your only treatment, if the cancer on the outer flap of your ear (the pinna) is small
- after surgery, particularly if your surgeon couldn't remove a border of healthy tissue from around the cancer
Radiotherapy after surgery can lower the chance of your cancer coming back.
The length of the radiotherapy course depends on the size of your cancer. Some people have radiotherapy for between 4 to 6 weeks. But your course might be shorter than this. You usually have treatment every day from Monday to Friday.
Before you start, your radiotherapy doctor plans your treatment. This means working out the dose of radiotherapy you need and exactly where you need it. Your planning appointment takes from 15 minutes to 2 hours. The treatment you have daily only takes a few minutes.
Side effects
The side effects of radiotherapy include:
- reddening of the skin of the ear
- sore and tender ear
- swelling around the ear
Your doctor, nurse or radiographer will go through all the side effects with you and tell you what you can do to help relieve them.
Rarely, the ear can become sore some time after treatment has finished. Tell your doctor as soon as possible if your ear changes colour or becomes sore.
Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to, but there are some general side effects you might experience regardless of where your cancer is. This video is about the general side effects you might have.
On screen text: Tiredness and weakness
Martin (Radiographer): As the normal cells repair themselves from the treatment this can use a lot of the body's resources, causing tiredness.
David: After about four weeks, I started to get tired. The body was starting to weaken.
Laurel: I was tired, day and night. Getting up in the morning was like a chore. I couldn't talk for 5 minutes. I would just sleep and just sleep and just wake up and sleep again.
Martin (Radiographer): Listen to your body. Take rests if you need to. Try not to overdo things.
Laurel: Don't fight with yourself too much. Just like go at a pace and just work with your body. If you can't make it today, you can't make it today.
David: You've got to rest. You have to take the time to rest.
Mary: Just going for them small walks. They really do help you. And even if it is just walking around your house or just walking around the block.
Martin (Radiographer): Doing exercise can help with tiredness by helping you maintain energy levels.
Mary: Being outside, that's a big, massive thing as well because you're feeling the fatigue and I think getting outside, just getting a bit of fresh air that really, really did help me.
Martin (Radiographer): The tiredness you can expect to begin within the first few weeks of treatment. Once it reaches its peak, about two weeks after treatment it recovers quite quickly after that.
Mary: It's not forever. You're not going to be like this forever and I did have to tell myself that.
Laurel: Two months after treatment, I start to feel less tired and that was a way forward because things start to really improve.
On screen text:
- Rest and have short naps when you need to
- Drink plenty of water
- Eat a balanced diet
- Do some gentle exercise
- Get some fresh air
On screen text: Sore skin
Martin (Radiographer): The radiotherapy can cause soreness of the skin. This only affects the area that you are having treated. This usually starts to appear about two weeks after you start treatment. You may notice this becoming more red and may become more itchy and sore as treatment continues.
David: After about ten days I started to get red on the area that they were targeting and it just progressively got redder and redder.
Laurel: My skin was dry and at the back was just like this triangle shape thing where it was like, okay, I'm a woman of colour, but it was really, really black.
David: Wasn't too painful, it was sort of annoying, rather than painful.
Martin (Radiographer): After treatment’s finished, the skin will remain sore for up to two weeks, but then recovers quite quickly.
Laurel: I haven’t got no scarring now at all.
David: It was maybe three or four weeks and then all the blemishes disappeared front and back.
Martin (Radiographer): When you start treatment we would advise you to carry on with your normal skincare routine but as the side effects develop, then your team will advise you on which products you can use on the skin safely.
Laurel: When I'm washing myself I use a sponge and you're just literally as it were just squirt it down, you don't rub the skin at all because it's already damaged. Pat dry, don't rub.
David: I spoke to the hospital about it and it was them that recommended this cream to put on, just to alleviate the symptoms.
Martin (Radiographer): We'd recommend wearing loose clothing and keeping the treatment area covered up against the sun and wind.
Laurel: I had to change most of my wardrobe. I only wore cotton.
David: Wearing T-shirts, soft clothing, nothing that would rub.
Mary: It's important when you go outside to make sure that you do wear that headscarf, or you do wear a hat or whatever it is.
Laurel: I wouldn't go in the sun at all, at all because my skin was - I know it was too delicate.
On screen text:
- Don’t rub the area, press if it is itchy and dab your skin dry
- Don’t use perfume, perfumed soaps or lotions on the area
- Don’t shave the area
- Only use creams or dressings advised by your specialist or radiographer
- Wear loose fitting clothing
- Avoid strong sun or cold winds
- Make sure you wear sunscreen
On screen text: Hair loss
Martin (Radiographer): Radiotherapy can cause hair loss in the area that's being treated, whereas chemotherapy can cause hair loss all over the body.
Mary: 2 to 3 weeks after the radiotherapy, I was brushing my hair and loads came out on the brush. I knew it was going to happen, but it was just hard when it happened.
Martin (Radiographer): In most cases the hair will grow back. This can take a couple of months and the hair may have a slightly different colour or texture.
Mary: Mine did grow back and there's a lot of grey in it so I have to dye it. This is not my original colour. It's very slow growing back.
Martin (Radiographer): Use a simple soap to clean the area. Be gentle with the skin in that area and after washing pat the area dry with a soft towel.
On screen text:
- Radiotherapy can make hair fall out in the treatment area
- It won’t cause hair to fall out in other parts of your body
- Your hair might grow back a few weeks after treatment ends
- If your hair won’t grow back, then your doctor should tell you
- Don’t use perfume, perfumed soaps, or lotions on the area
On screen text: Your mental health
Laurel: I felt frustrated. Some days were really, really challenging where there were just tears without words.
Mary: It's a mixture of emotions. You feel angry and you feel frustrated. You lose your confidence.
Martin (Radiographer): Radiotherapy can cause a lot of emotions at various times during the treatment. You may feel sad or anxious or depressed, which is quite normal. It's good to talk to people about your experiences, whether that's your team at the hospital or friends and family.
David: I couldn't praise the team highly enough. Everybody that was involved were unbelievable and if it hadn't been for them, I just don't think I would have gotten through with it.
Mary: I did have a nurse as well and she had the experience of dealing with people that went through brain surgery, went through radiotherapy so it was just great that I could reach out.
Martin (Radiographer): Your team will be able to give you information about local patient support services that are available, that includes things like counselling and complementary therapies.
Laurel: A referral from the hospital counselling, which I attended for about a year.
Martin (Radiographer): There's also lots of support available online and in your local area.
Mary: I went on loads of different forums and I spoke to loads of different people and it really, really helped me. If I didn't do that, I don't think I would have got through most days.
Laurel: If you get a bit cranky or feel a bit low, go for it. But there's so much help out there and that's why I'm pushing forward like don't sit down in silence. It's the same thing, just get the help you need.
On screen text:
- There is help available – ask the hospital for support
- Talk to your friends and family about how you are feeling
- Ask about local support groups
- Your GP or hospital can provide counselling
- You can get help and support online through forums
If you're experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
On screen text: For more information go to: cruk.org/radiotherapy/side-effects
Follow up
You 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.
Coping
Coping with a diagnosis of cancer can be difficult. Being well informed about your cancer and its treatment can help. It can make it easier to make decisions and cope with what happens.
Talking to other people who have the same thing can also help.
Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people.
You can call our nurse freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.
