Ear melanoma: a four-case series

Gastric metastasis from nodular malignant melanoma of the auricle with multigene aberrations: A rare case report and literature review

Primary malignant melanoma (MM) of the external ear accounts for a low proportion of cases of cutaneous MM, and its incidence in non-white women is very low. The stomach is a rare metastatic site for MM. Gastric metastasis of MM of the external ear is extremely rare, and the associated gene alterations and mechanisms are poorly understood. The present report describes the case of a 58-year-old Asian woman who had a mass on the left auricle for 5 years and was diagnosed with nodular MM with the BRAF V600E mutation after surgical resection. Postoperative metastases to the stomach and descending duodenum appeared 1 year after resection. After 11 months of BRAF-targeted therapy and immunotherapy, the patient developed drug resistance and died from systemic metastases to the brain, lungs, liver, left adrenal gland and peritoneum. Genetic testing revealed additional aberrations in MYB, p16, MYC and PTEN. The clinical characteristics of MM of the external ear and gastric metastatic MM were also summarized through a retrospective literature review. Immunohistochemical staining is critical in the diagnosis of gastric metastasis from MM of the external ear. This disease often requires a multidisciplinary treatment approach, including surgery, targeted therapy and immunotherapy. The present study provides some genetic information about this rare disease and discusses appropriate treatment strategies. The findings of the present study suggests that the surgical margin size, tumor histological type and number of genetic aberrations may be closely associated with metastasis potential, therapeutic efficacy and patient outcome.

Malignant Melanoma of the External Auditory Canal on 68 Ga-FAPI PET/CT

ABSTRACT

External ear melanomas are relatively rare and usually occur in the regions of helix and ear lobes. Rarer still are primary melanomas of the external auditory canal. We report findings of melanoma of the external auditory canal on 68 Ga-FAPI PET/CT in a 56-year-old man who presented with sharp pain in the external auditory canal for 7 months.

Malignant lesions of the ear

The dermatologic lesions of the external ear are quite protean and they encompass pre-malignant, malignant and inflammatory entities. The ear is endowed with functional and cosmetic importance and it is part of the "H-zone", which is the area of the head that generally presents tumors that can be considered high risk regardless of their size. As a matter of fact, skin malignancies of the ear tend to have a less benign course compared to the ones located on other areas of the body and complete excision has proven to be challenging. This mini-review provides an overview on the malignant cutaneous lesions of the external ear with a focus on their dermoscopic and reflectance confocal microscopy features. The most prevalent neoplasms of the auricle are squamous cell carcinoma and basal cell carcinoma followed by melanoma. These malignant lesions appear to be more common in men and to have a worse prognosis compared to when they arise from other body districts. There is a relative dearth of large studies centered on the clinical, dermoscopic and reflectance confocal microscopy features of skin cancers of the ear. Hence, further research inquiring into the specific dermoscopic and reflectance confocal microscopy characteristics of the cutaneous malignant lesions of the external ear, if any, are warranted for the future.

Morphological features of benign pigmented ear lesions: a cross-sectional study

BACKGROUND

The morphology of benign pigmented lesions on the ears has been scarcely studied.

METHODS

We prospectively screened all patients presenting to a pigmented lesion clinic at a tertiary academic hospital, between November 2015 and August 2016, for the presence of benign pigmented ear lesions. Clinical and dermoscopic images were obtained for all lesions. Additionally, we performed a retrospective analysis of reflectance confocal microscopy (RCM) of benign pigmented ear lesions and a retrospective analysis of clinical and dermoscopic findings of biopsy-confirmed ear melanomas.

RESULTS

In total, 165 patients (median age 48, 53% female) contributed 708 benign pigmented ear lesions to the study. Participants with multiple body nevi and those with an atypical nevus phenotype (multiple body nevi and ≥ one atypical nevus) had a higher mean number of ear lesions than those without multiple body nevi (4.5 and 5.4 vs. 3.9, P < 0.05). The most common diagnoses were nevus (35%) and solar lentigo (34%), followed by pigmented lentiginous macules (PLM) (27%). Dermoscopically scattered pigmented small globules/dots were observed in 30% of nevi and 17% of PLMs. RCM analysis of 24 ear lesions showed a comparable frequency of RCM-clods between nevi and PLMs. Analysis of 29 ear melanomas revealed larger lesions with more complex dermoscopic patterns.

CONCLUSION

Multiple body nevi, and particularly an atypical nevus phenotype, were associated with having more pigmented ear lesions. Based on RCM analysis, PLMs of the ear likely represent small nevi. Ear melanomas tend to be larger and dermoscopically complex compared to ear nevi.

Auricular and periauricular melanomas have similar clinicopathologic factors and survival rates

BACKGROUND

Auricular melanomas are rare malignancies, and conflicting reports regarding their clinical behaviors have been published so far.

OBJECTIVE

In this study, we investigated the clinical features of the auricular melanomas and compared them with periauricular skin melanomas.

METHODS

Data of 53 primary melanomas arising in auricular (n = 25) and periauricular regions (n = 28) were analyzed retrospectively.

RESULTS

Demographic, histopathological, and clinical characteristics were found similar between auricular and periauricular melanomas (p > 0.05). Likewise, the recurrence rates for both groups were found to be similar (30%) (p = 0.9). The 5-year relapse-free survival rate of all patients was 57.4%, and no statistical difference was observed between the two groups-63.9% for auricular melanomas and 51.7% for periauricular melanomas (p = 0.5). Moreover, the 5-year overall survival rate of all melanomas was 46.9%, and there was no statistical significance between the two groups-56.1% and 37.4% for auricular and periauricular melanomas, respectively (p = 0.4).

CONCLUSION

Auricular and periauricular melanomas share similar clinicopathologic features and outcomes.