Oct. 31, 2025
Surgical excision of an ear in patients with skin cancer is rare. However, in cases of advanced cancer or when Mohs surgery is not an option, removing the affected ear may be indicated.
Patients who have an ear removed to treat cancer are a unique population. Unlike those who lose hearing on one side for an ear-related condition, patients with cancer often need the primary disease addressed before their hearing concerns can be addressed. Mayo Clinic takes a collaborative approach when caring for these patients, relying on a team comprising a head and neck cancer surgeon, neurotologist, and audiologist.
"These complex cases require a precisely coordinated effort," says Greta C. Stamper, Au.D., Ph.D., the chair of Audiology at Mayo Clinic in Jacksonville, Florida. "Our goal is to minimize the number of surgeries and appointments a patient needs while maximizing their hearing function."
When head and neck cancer surgeons determine that treatment will involve surgically removing the ear, they connect with a neurotologist and audiologist. Establishing a specialized multidisciplinary team prior to surgery ensures that every aspect of hearing restoration is considered before the ear is removed. It also helps provide patients with a more comprehensive understanding of the treatment and recovery process so they can manage their expectations.
"These patients are different from other patients I see because their hearing prior to surgery is typically fairly normal," says Dr. Stamper. "They aren't seeing me because they are having hearing problems. It's because their surgery is going to drastically change their hearing function. It's a challenging situation, and educating the patient on the process can help prepare them for what's to come."
Using a bone-anchored hearing device to restore hearing
Maximizing hearing function after ear removal is a complex process. When the cochlea is intact and functional — which is typical in people with ear removal due to skin cancer — a bone-anchored hearing device (BAHD), also called a bone-anchored implant or a bone-anchored hearing system, can be an excellent option. It uses a surgically implanted device and an external sound processor to bypass the outer and middle ear. A BAHD directs sound straight to the cochlea by transmitting sound waves through the skull.
Placing a traditional, known as percutaneous, or transcutaneous BAHD involves a multistep process:
- Embedding a titanium implant into the skull and waiting for the skull to grow around the implant, which typically takes 1 to 3 months. A transcutaneous BAHD implant includes a magnetic component.
- Inserting an external abutment and connecting it to the implant using ultrasound to guide placement, a step that is not necessary for transcutaneous BAHD placement.
- Programming and attaching the bone-anchored implant processor to the outside of the head, either through a percutaneous abutment or magnetic transcutaneous connection.
"Patients don't get a bone-anchored implant one day and then have a working device and improved hearing the next," says Dr. Stamper. "It's a complicated process that involves time for healing. And when the patient has skin cancer, the priority is managing the primary disease."
A collaborative surgical approach to removing cancer and placing a bone-anchored implant
To prioritize cancer treatment and initiate the BAHD process, head and neck surgeons and neurotologists perform a combination surgery that involves:
- Excising the skin cancer.
- Removing the external ear.
- Anchoring the hearing implant in the skull.
Surgeons perform skin grafting and wait for the patient to recover. The team needs to assess the body's acceptance of the skin graft and see that it remains healthy and heals well. The team also needs to ensure that the skin cancer has been fully addressed.
"Healing issues can slow down hearing restoration," says Dr. Stamper. "For some patients, it can be up to a year after having the external ear removed before we can confidently say that the skin is in a stable state. Only then can we move forward with the bone-anchored implant process."
During that time, patients can hear only on one side. They may struggle to distinguish sounds from background noise or identify the source of the sound, known as localization. Patients should be prepared for this stage after discussing it with their audiologist prior to surgery.
If an external abutment is needed, a neurotologist will locate the previously placed implant, either with a brief surgical procedure in the operating room or with ultrasound in the office under local anesthesia. Once the implant is located, the surgeon can place the external abutment. This step is done once the primary disease has been addressed and healing is complete.
Within a week, the audiologist attaches the external processor to the abutment. If an external abutment is not needed, the external processor can be attached using a magnetic connection.
A BAHD processes speech like a traditional hearing aid, but the sound undergoes a mechanical transformation to ensure the inner ear is stimulated and activated. Patients follow up with the audiologist as needed for device adjustments to ensure a comfortable and pleasant sound perception.
"These are complicated cases, and patients may receive follow-up care for cancer and their skin graft long after their hearing is restored," says Dr. Stamper. "Our multidisciplinary approach addresses patient concerns from a multitude of facets. We consider their medical, rehabilitation and functional needs to provide comprehensive support."
For more information
Refer a patient to Mayo Clinic.