Malignant melanoma of the external ear canal

Abstract

A 40-year-old man was referred to us with a 1-year history of worsening deafness in his left ear. He was assumed to have ceruminous accumulation, such that his ear canal was occluded with black wax. Otoscopy showed a smooth, black mass blocking the left ear canal. The operator could not see or manoeuvre beyond the mass, which seemed to be rooted anteroinferiorly. CT confi rmed a soft-tissue lesion eroding through the anterior meatal wall into retromandibular, but not parotid, tissue. Moreover, neck palpation showed left cervical lymphadenopathy. Ultrasonography confi rmed pathological nodes, and fi ne-needle aspiration cytology confi rmed metastatic malignant melanoma. The patient chose lateral temporal bone resection, superfi cial parotidectomy, selective neck dissection, and postoperative radiotherapy. Although rare, malignant melanoma of the external ear canal is especially dangerous, because detection is delayed due to its hidden location. Melanoma thicker than 4 mm has a very poor prognosis, and ear canal melanomas are typically thicker than that. Black wax is not typical of ceruminous gland secretions, therefore, the presence of material resembling black wax should be viewed as an ominous sign. Malignant melanoma of the external ear canal