ASCLEIPUS SPECIAL ISSUE April 2016
CONTENTS 3 BENIGN EAR CYST 6 EXTERNAL EAR CANAL OSTEOMAS 9 KELOIDS 12 BASAL CELLS CARCINOMA 13 SQUAMOUS CELL CARCINOMA
Noncancerous tumors
Benign Ear Cyst
A benign ear tumor can be any growth arising from tissues in the external ear canal, the eardrum, or the middle ear space. The most common type of benign ear cyst is a cholesteatoma (also known as keratoma). A cholesteatoma is a cyst that forms usually in the middle ear (the space behind the eardrum). There are several ways that a cholesteatoma can form. They can result from remnants of skin in the middle ear left over from the embryologic process of middle ear development (congenital cholesteatomas), from a retraction pocket (condition in which a part of the eardrum lies deeper within the ear than its normal position) arising, and if there is a perforation
in the eardrum. This is particularly likely if the edge of the hole is in contact with the outer ear canal. The only way to treat a cholesteatoma is to have it surgically removed. The cyst must be removed to prevent the complications that can occur if it grows larger. Cholesteatomas don’t go away naturally. They usually continue to grow and cause additional problems. Causes: besides repeated infections, a cholesteatoma may also be caused by a poorly functioning Eustachian tube, which is the tube that leads from the back of the nose to the middle of the ear. Eustachian tube problems tend to run in families or certain ethnic groups, such as Eskimos or individuals of American Indian descent. Other disorders, such as cleft palate, Down’s syndrome, or other craniofacial abnormalities that impair Eustachian tube function may also have a higher frequency of cholesteatoma formation. Prevention: congenital cholesteatomas cannot be prevented, but parents should be aware of the condition so that it can quickly be identified and treated when present. You can prevent cholesteatomas later in life by treating ear infections quickly and thoroughly. However, cysts may still occur. It’s important to treat cholesteatomas as early as possible to prevent complications. Call your doctor right away if you believe you have a cholesteatoma.
External Ear Canal Osteomas
Osteomas’ of the external ear canal, also known as “Surfer's ear� are common, generally asymptomatic abnormal bone growth within the ear canal found in persons who have a history of swimming in the lake or ocean in their youth. Surfer's ear is not the same as swimmer's ear, although infection can result as a side effect. Causes: irritation from cold wind and water exposure causes the bone surrounding the ear canal to develop lumps of new bony growth which constrict the ear canal. Where the ear canal is actually blocked by this condition, water and wax can become trapped and give rise to infection. The condition is so named due to its prevalence among cold water surfers. Warm water surfers are also at risk for osteomas due to the evaporative cooling caused by wind and the presence of water in the ear canal.Most avid surfers have at least some mild bone growths, causing little to no problems. The condition is progressive, making it important to take preventative measures early, preferably whenever surfing. The condition is not limited to
surfing and can occur in any activity with cold, wet, windy conditions such as windsurfing, kayaking, sailing, jet skiing, kitesurfing, and diving. Prevention: the widespread use of wetsuits has allowed people to surf in much colder waters, which has increased the incidence and severity of surfer's ear for people who do not properly protect their ears. Some recommendations are: o
Avoid activity during extremely cold or windy conditions.
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Keep the ear canal as warm and dry as possible.
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Ear plugs
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Neoprene hood
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Swim cap
According to new research surfers are 17 times less likely to develop surfer's ear if they wear a cap and ear plugs together.
Keloids
Keloids are raised overgrowths of scar tissue that occur at the site of a skin injury. Keloids differ from normal mature scars in composition and size. Some people are prone to keloid formation and may develop them in several places. They are more common in African-Americans. Keloids usually appear in areas of previous trauma but may extend beyond the injured area. They are shiny, smooth and rounded skin elevations that may be pink, purple, or brown. They can be doughy or firm and rubbery to the touch, and they often feel itchy, tender or uncomfortable. They may be unsightly. A large keloid in the skin over a joint may interfere with joint function. Causes: they occur where trauma, surgery, blisters, vaccinations, acne or body piercing have injured the skin. Less commonly, keloids may form in places where the skin has not had a visible injury. Prevention: People who are prone to keloids should avoid cosmetic surgery. When surgery is necessary in such people, doctors can take special precautions to minimize the formation of keloids at the site of the incision. Examples of techniques that might be used to minimize keloid formation include covering the
healing wound with hypoallergenic paper tape for several weeks after surgery, covering the wound with small sheets made of a silicone gel after the surgery, or using corticosteroid injections or radiation treatments at the site of the surgical wound at the beginning of the healing period.
Cancerous Tumors Basal Cells Carcinoma
Is a common skin cancer that can develop on the external ear after repeated and prolonged exposure to the sun. They originate in the cells of the outer layer of the skin (epidermis). Usually, a small, shiny bump appears on the skin and enlarges slowly. The bumps may break open and form a scab, sometimes with bleeding, or become flat, resembling a scar. Although this cancer can often be identified by sight, doctors usually do a biopsy. Basal cell carcinomas rarely spread (metastasize) to other parts of the body. Instead, they invade and slowly destroy surrounding tissues. When basal cell carcinomas grow near the eyes, ears, mouth, bone, or brain, the consequences of spread can be serious and can lead to death. Yet, for most people, the tumors simply grow slowly into the skin. The cancer is usually removed, but sometimes people may be given chemotherapy drugs applied to the skin or, occasionally, radiation therapy or drug therapy. Causes: basal cell carcinoma is the most common type of skin cancer. It is more common among fair-skinned people with a history of sun exposure and is very rare among dark-skinned people. Basal cell carcinoma usually develops on skin surfaces that are exposed to sunlight, commonly on the head or neck. Prevention: because basal cell carcinoma is often caused by sun
exposure, people can help prevent this cancer by doing the following: o
Avoiding the sun:
seeking shade, minimizing outdoor activities between 10 am and 4 pm (when the sun’s rays are strongest), and avoiding sunbathing and the use of tanning beds o
Wearing protective
clothing (long-sleeved shirts, pants, and broad-brimmed hats) o
Using sunscreen: At least
sun protection factor (SPF) 30 with UVA and UVB protection used as directed and reapplied every 2 hours and after swimming or sweating but not used to prolong sun exposure. In addition, any skin change that lasts for more than a few weeks should be evaluated by a doctor.
Squamous cell carcinoma
is cancer that begins in the squamous cells of the skin. Squamous cells (keratinocytes) are the main structural cells of the epidermis (the outer layer of skin). Thick, scaly growths appear on the skin and do not heal. To diagnose the cancer, doctors do a biopsy. If the cancer spreads to other parts of the body, it can be fatal. Causes: squamous cell carcinoma, the second most common type of skin cancer after basal cell carcinoma, usually develops on sun-exposed areas but may grow anywhere on the skin or in the mouth, where sun exposure is minimal. However, people ho have had more sun exposure to their skin have a higher risk of developing squamous cell skin cancer. Fair-skinned people are much more susceptible to squamous cell carcinoma than darker-skinned people. Squamous cell carcinoma may develop on normal skin but is more likely to develop in damaged skin. Such damage includes: o
Precancerous skin growths caused by previous sun exposure
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Chronic sores—such as chronic skin ulcers
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Skin that has been scarred, particularly by burns.
People who have chronic ear infections may have an increased risk of developing squamous cell carcinoma. Prevention: because
squamous cell carcinoma is often caused by sun exposure, people can help prevent this cancer by doing the following: o
Avoiding the sun: seeking shade, minimizing outdoor
activities between 10 am and 4 pm (when the sun’s rays are strongest), and avoiding sunbathing and the use of tanning beds o
Wearing
protective clothing (long-sleeved shirts, pants, and broadbrimmed hats) o
Using sunscreen:
At least sun protection factor (SPF) 30 with UVA and UVB protection used as directed and reapplied every 2 hours and after swimming or sweating but not used to prolong sun exposure.