Melanoma of the external ear: A population-based study

Lentigo Maligna and Lentigo Maligna Melanoma of the External Ear: Clinical and Dermoscopic Features of 19 Patients

External ear lentigo maligna/lentigo melanoma (LM/LMM) represents approximately 1%-4% of all primary cutaneous melanomas. Over the past 20 years, dermoscopy has proven highly effective in early detection of LM/LMM, with recent studies identifying perifollicular linear projections (PLP) as a specific diagnostic criterion for early LM. However, in clinical practice, LM and LMM turn out to be very difficult to distinguish based on dermoscopic findings. Therefore, our retrospective monocentric study aimed to investigate dermoscopic characteristics, as well as the epidemiological and clinical data of 19 patients diagnosed with the external ear (EE) LM/LMM at the Oncologic Dermatology Unit in Bologna. Dermoscopic images were obtained using the FotoFinder Medicam 800HD, and specific criteria validated by the International Dermoscopy Society (IDS) for atypical pigmented facial lesions were assessed. Fisher's exact test was primarily used for statistical comparisons. As results, most of the patients were male (74%) with an average age (± SD) at diagnosis of 69.8 (± 15.1) years old. LMM appeared more commonly observed in elderly patients as compared to LM (mean 71.6 vs. 66.7, p = 0.514), presenting as pigmented macule (89.5%) of the ear lobule (23.9%). A statistically significant difference (p = 0.01) of tumour' diameter between LMM and LM was reported with the first resulting more than twice the size of the latter. Concerning dermoscopic findings, asymmetric pigmented follicles, obliteration of the follicular openings and grey circles were more frequently observed in LMM compared to LM (63.2% vs. 31.6%; 63.2% vs. 26.3%; 47.4% vs. 15.8%, respectively).

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.

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.

Skin Cancer in People of Color: A Systematic Review

BACKGROUND

People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS).

OBJECTIVES

In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature.

METHODS

An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search.

RESULTS

We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review.

CONCLUSION

Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.

Clinical and Dermoscopic Features of Melanocytic Lesions on the Face Versus the External Ear

Introduction

Melanoma of the external ear is a rare condition accounting for 7-20% of all melanomas of the head and neck region. They present classical features of extra-facial melanomas clinically and dermoscopically. In contrast, facial melanomas show peculiar patterns in dermoscopy.

Objectives

To evaluate whether there are clinical and/or dermoscopic differences in melanocytic lesions located either at the external ear or on the face.

Methods

In this retrospective study we reviewed an image database for clinical and dermoscopic images of melanomas and nevi located either on the face or at the level of the external ear.

Results

65 patients (37 men; 63.8%) with 65 lesions were included. We found no significant differences in comparing face melanomas with melanomas at the level of the external ear, neither clinically nor dermoscopically. However, we provided evidence for differences in some clinical and dermoscopic features of melanomas and nevi of the external ear.

Conclusions

In this study, we reported no significant differences in comparing melanomas on the face with melanomas of the external ear, both clinically and dermoscopically. Furthermore, we provided data on clinical and dermoscopic differences comparing nevi and melanoma of the external ear.

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.

Ear melanoma: a four-case series

External ear melanoma is rare, and early diagnosis and treatment are paramount for the patient's survival. Four clinical cases are reported, emphasizing the importance of the routine clinical examination of the ears in the dermatological consultation. The study included male and female patients, aged 60 to 81 years old, with melanocytic lesions in the outer ear, evaluated with detailed physical and dermoscopic examination, leading to the identification of lesions suggestive of melanoma. The cases were treated surgically with excision of the lesion, and the diagnoses were confirmed by histopathological study. The therapeutic approach was instituted early as most cases were diagnosed at an early stage, which directly impacted global survival.