External Ear Melanoma Research Articles

Dermoscopy of external ear melanoma (EEM).

External ear melanoma (EEM) belongs to extremely rare melanoma locations. So far, only single cases of EEM have been described in terms of dermoscopic presentations. This case study report presents dermoscopic patterns of EEM in six patients. The retrospective case study was based on medical documentation (epidemiological, anamnestic, clinical, videodermoscopic, and histopathologic) of consecutive patients who were diagnosed with melanoma located on the external ear between January 2013 and May 2021 in three diagnostic dermatologic centers. In four of six cases, the melanoma was placed on the helix. The histopathological diagnoses included 1/6 lentigo maligna and 5/6 invasive melanomas. The dermoscopic pattern of facial melanoma (FM) was present in 3/6 cases, 1/6 exhibited the typical superficial spreading pattern (one with nodular invasion), 1/6 the multicomponent asymmetric pattern, and 1/6 the hypomelanotic type. Five melanomas presented numerous (3-6) dermoscopic structures characteristic for each dermoscopic subtype. In conclusion, dermoscopy has proved effective for detection of both difficult and easy-to-diagnose EEM, but also in differentiating their dermoscopic subtypes.

Recurrence risk of early-stage melanoma of the external ear: an investigation of surgical approach and sentinel lymph node status.

Surgical management of external ear melanoma presents unique technical challenges based on the unique anatomy and reconstruction concerns. Surgical technique, including preservation of cartilage, is variable and impact on recurrence is unclear. Our goal was to investigate surgical approach, including extent of surgical resection and sentinel lymph node biopsy (SLNB), and the impact on recurrence. In this retrospective review of primary clinical stage 1/2 external ear melanoma, demographics, tumor characteristics, surgical resection technique (including cartilage-sparing vs. cartilage removal), and SLNB results were evaluated for recurrence risk. One hundred and fifty-six patients total had an average follow-up of 5.6 years. Twenty-nine (18.6%) patients underwent cartilage-sparing surgery and 99 (63.5%) patients underwent SLNB, 14.1% of whom had micrometastatic disease. Ten (6.4%) patients recurred loco-regionally. Recurrence was associated with Breslow depth, initial stage at diagnosis, and SLNB status. Cartilage-sparing surgery was not associated with increased recurrence. Sentinel lymph node identification rate was 100% based on clinical detection with use of lymphoscintigraphy. In addition to confirming established risk factors for melanoma recurrence, we confirm the feasibility of SLNB in stratifying recurrence risk. Although we did not see an increased recurrence risk with surgical technique and cartilage-sparing approaches, these findings are limited by small sample size.

Outcomes of Cartilage-Sparing Wide Local Excision for Primary Melanoma of the External Ear.

ObjectiveTo describe outcomes after cartilage-sparing wide local excision for primary melanoma of the external ear.Study DesignRetrospective analysis of patients undergoing external ear melanoma excision using a cartilage-sparing approach at a university-based tertiary care center between 2010 and 2018.SettingUniversity-based tertiary care center.Subject and MethodsChart review was performed for all patients over age 18 who were treated for melanoma of the external ear at Massachusetts Eye and Ear between 2010 and 2018. Patients with melanoma in situ or with melanomas in noncartilaginous areas of the ear (eg, lobule) were excluded.ResultsA total of 8 patients underwent cartilage-sparing excision. Sentinel lymph node biopsy was performed in 7 patients, with positive lymph nodes in 1 of 7 cases. Positive margins and local recurrence occurred in 1 of 8 (12.5%) patients during a mean (SD) follow-up time of 22.5 (15.1) months (SE, 5.3 months). No distant metastasis or death was observed.ConclusionCartilage-sparing wide local excision for melanoma of the external ear is a surgical approach that enables surgeons to follow guideline-recommended oncologic excision margins but has the added benefit of improved postoperative aesthetic outcomes as well as reconstructive options through preservation of the auricular cartilage framework.

National Analysis of Patients With External Ear Melanoma in the United States.

External ear melanoma (EEM) is a rare condition with controversies in the literature. We analyzed patients with EEM in the United States compared to other head and neck melanomas (OHNMs). The National Cancer Database (NCDB) was used to select patients with head and neck melanoma from January 1, 2004 to December 31, 2015. Mann-Whitney and χ tests were used to estimate statistical significance, and multivariate logistic regression to identify independent associations adjusted for confounders. A total of 137,233 patients met the study criteria. Among them, 16,991 (12.4%) had EEM and 120,242 (87.6%) had OHNM. For patients with EEM, the mean (standard deviation) age was 66.26 (15.798) years. Most of the patients with EEM were men (85.5%), insured by Medicare (52.4%), and treated in Academic/Research Programs (47.7%) or Comprehensive Community Cancer Programs (32.3%). Most of the EEM tumors had invasive behavior (68.0%) were Stages 0 (30.3%) or I (40.3%), and were without ulceration (76.9%). Mean time to receive any treatment was 14.1 days for EEM compared with 14.6 days for OHNM (P < 0.001). We noticed a greater proportion of EEM in men (14.8%; adjusted odds ratio [aOR] 2.72 [2.605-2.852]; P < 0.001) compared to women (6.22%; reference). EEM was an independent factor for tumor Stage I (14.47%; aOR 1.61 [1.101-1.224], P < 0.001) and invasive behavior (13.86%; aOR 1.268 [1.15-1.389]; P < 0.001) compared to OHNM. EEM was associated with higher odds of invasive behavior compared to OHNM. Furthermore, men were found to have a higher likelihood to develop EEM compared to women.

Challenges in Diagnosis and Management of External Ear Melanoma Case Report and Literature Review

Primary external ear melanomais a rare disease that accounts for only 1% of all cutaneous melanomas and only 14,5% of cutaneous melanomas of the head and neck region [1]. The external ear represents a site with high ultraviolet exposure and predisposed to various cutaneous lesions. The path physiology of these tumors is different from other skin lesions because of their specific anatomical site close to cartilage, lymphatic drainage and functional characteristics. Malignant melanoma of the ear was considered to be very aggressive, with a propensity for spreading to both regional lymph nodes and distant sites. Surgical management of external ear melanoma has always been a challenge between avoiding aggressive amputations, achieving an aesthetic pleasant result and adequate oncologic control. According to our literature review a limited number of publications exist regarding malignant melanoma of the external ear. We present the case of a 69-year-old woman, who was presented at the Department of Dermatology because of an ulcerated lesion in the helix part of the left ear. Clinical, histopathological and immunohistochemical examination confirmed the diagnosis of malignant melanoma of the external ear, nodular type, ulcerated.

A Systematic Review of Surgical Management of Melanoma of the External Ear.

Background:Historically, external ear melanomas have been treated aggressively, due to early perceptions suggesting they had poor prognosis and aggressive biological behavior. More recent evidence has not supported these notions.Methods:We completed a complete review of the literature involving malignant melanoma of the external ear. We then completed a quantitative analysis on seventy-three cases from 8 reports that contained case-level data, assessing factors that influence recurrence, and assessing characteristics of the melanomas based on histological subtype. Baseline and outcomes data for all 20 studies were then compiled but not statistically evaluated.Results:In our subanalysis, patients who had recurrence were significantly more likely to have had wedge resection versus wide-local excision, and those with no recurrence were more likely to have undergone wide local excision. Nodular tumors had significantly greater thickness. Overall, conservative excisions provided excellent outcomes.Conclusions:Conservative treatment for external ear melanoma produces satisfactory outcomes. There is no evidence to support the use of radical amputation and little evidence to support the removal of cartilage or perichondrium. Sentinel lymph node biopsy is warranted only with positive nodes. There is no role for elective neck dissection. The roles for chemo/radiation therapy are unclear and guidelines for other cutaneous melanomas should be followed.

A Population Based Analysis of Melanoma of the External Ear.

Malignant melanoma accounts for nearly 75% of all skin cancer deaths, and the incidence is on the rise in the United States. External ear melanoma (EEM) is rare, and there is little long-term data regarding the clinical behavior of this melanoma site. This study analyzes the demographic, clinicopathologic, and survival characteristics of EEM. The SEER database was queried for EEM cases from 1973 to 2012 (8,982 cases). Data analyzed included patient demographics, incidence trends, and survival outcomes. External ear melanoma occurred most frequently in the sixth and seventh decades of life. Mean age at diagnosis was 65.5 (±16.8) years. However, the incidence of EEM in adolescents and young adults (ages 15-39 yr) has increased by 111.9% from 1973 to 2012. There was a strong male predilection with a male-to-female ratio of 6.40:1. The most common histologic subtype was malignant melanoma, NOS (46.8%), followed by superficial spreading melanoma (21.4%), and lentigo maligna melanoma (17.9%). The majority of cases were localized at the time of presentation (88.0%), with rare distant metastasis (1.9%). The most common treatment modality was surgery alone (97.6%), followed by surgery with radiotherapy (2.3%). Ten-year disease-specific survival was better among those treated with surgery alone (90.7%), than those treated with surgery with radiotherapy (37.1%) (p < 0.0001). Increasing Breslow's thickness and presence of an ulcerating lesion were both associated with poorer survival (p < 0.0001). This study represents the largest cohort of EEM. It has an excellent survival outcome with surgery being the treatment of choice.

Management of external ear melanoma: the same or something different?

BackgroundThe external ear represents a site with high ultraviolet exposure and thin skin overlying cartilage. The aim of this study was to determine if ear melanomas have different characteristics than cutaneous melanomas in other anatomic sites. MethodsThe evaluation of patients treated at a tertiary care center. ResultsSixty patients were treated for ear melanoma (87% male, mean age = 56.7, mean thickness = 1.65 mm). Seven of thirty-two patients (22%) who underwent sentinel lymph node biopsy had positive nodes. Twenty (33%) patients had recurrence including 6 patients with negative sentinel lymph nodes (SLNs) and 5 patients with positive SLNs. Three of 10 patients (30%) treated with Mohs surgery had local recurrence. ConclusionsThe overall local and systemic recurrences are similar to those previously reported. There is a higher recurrence rate than expected in patients with a negative SLN and a high local recurrence rate after Mohs surgery. Our data suggest that SLN evaluation may be less accurate in ear melanomas and that Mohs surgery may be associated with a relatively high local recurrence rate.