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Squamous cell carcinoma

This picture shows squamous cell carcinoma of the head & neck (HNSCC) due to HPV infection, a commonly implicated pathogen in the development of HNSCC, especially in younger populations. Although the most common risk factors are tobacco and alcohol consumption and the incidence of head/neck cancer peaks among older males, HPV has promoted a significant shift towards increased HNSCC rates in young, sexually active non-smokers. Clinical symptoms vary depending on the primary site of the tumor, but a common presenting complaint is ear pain by way of a phenomenon known as referred otalgia, considered to be a red flag in the evaluation of a patient with suspected head and neck malignancy. This occurs because the mucosa of the pharynx, larynx, and other local structures are extensively innervated by cranial nerves [re: CN 5, 7, 9, 10] that also contribute afferent fibers to the external and middle ear, and irritation of the nerves due to growth of the tumor can send pain signals to the ear.