Decades in the Making: A Rare Case of Mastoid Squamous Cell Carcinoma Following Chronic Otitis Media and Mastoidectomy.

Squamous cell carcinoma (SCC) of the mastoid, a subtype of temporal bone SCC (TBSCC), is a rare and aggressive malignancy often associated with chronic otologic conditions such as chronic otitis media (COM) and mastoiditis. We present the case of a 67-year-old male with a lifelong history of COM and a childhood mastoidectomy who developed SCC of the right mastoid decades later. The patient developed worsening otologic symptoms, including persistent bloody ear discharge that ultimately led to diagnosis via mastoid biopsy. Surgical resection revealed poorly differentiated SCC involving the mastoid, middle ear, and adjacent structures, with positive margins due to tumor adherence to the dura. The patient was treated with adjuvant radiation and cisplatin-based chemotherapy, resulting in no evidence of recurrence or metastasis at follow-up. This case shows that chronic ear disease can, in rare instances, progress to malignancy and reminds clinicians to stay alert when otologic symptoms worsen or persist. It also illustrates the importance of early biopsy and imaging in differentiating benign chronic inflammation from malignant transformation. Despite incomplete resection, the patient's favorable response to multiple forms of therapy suggests that aggressive combined treatment can still give meaningful disease control. Increased awareness, early diagnosis, and comprehensive management strategies are critical to improving outcomes in patients at risk for TBSCC.