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Bittar PG, Bittar JM, Etzkorn JR, Brewer JD, Aizman L, Shin TM, Sobanko JF, Higgins HW, Giordano CN, Cohen JV, Pride R, Wan MT, Leitenberger JJ, Bar AA, Aasi S, Bordeaux JS, Miller CJ. Systematic review and meta-analysis of local recurrence rates of head and neck cutaneous melanomas after wide local excision, Mohs micrographic surgery, or staged excision. J Am Acad Dermatol 2021; 85:681-692. [PMID: 33961921 DOI: 10.1016/j.jaad.2021.04.090] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Prospective trials have not compared the local recurrence rates of different excision techniques for cutaneous melanomas on the head and neck. OBJECTIVE To determine local recurrence rates of cutaneous head and neck melanoma after wide local excision (WLE), Mohs micrographic surgery (MMS), or staged excision. METHODS A systematic review of PubMed, EMBASE, and Web of Science identified all English case series, cohort studies, and randomized controlled trials that reported local recurrence rates after surgery for cutaneous head and neck melanoma. A meta-analysis utilizing a random effects model calculated weighted local recurrence rates and confidence intervals (CI) for each surgical technique and for subgroups of MMS and staged excision. RESULTS Among 100 manuscripts with 13,998 head and neck cutaneous melanomas, 51.0% (7138) of melanomas were treated by WLE, 34.5% (4826) by MMS, and 14.5% (2034) by staged excision. Local recurrence rates were lowest for MMS (0.61%; 95% CI, 0.1%-1.4%), followed by staged excision (1.8%; 95% CI, 1.0%-2.9%) and WLE (7.8%; 95% CI, 6.4%-9.3%). LIMITATIONS Definitions of local recurrence varied. Surgical techniques included varying proportions of invasive melanomas. Studies had heterogeneity. CONCLUSION Systematic review and meta-analysis show lower local recurrence rates for cutaneous head and neck melanoma after treatment with MMS or staged excision compared to WLE.
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Affiliation(s)
- Peter G Bittar
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Julie M Bittar
- Section of Dermatology, Rush University Medical Center, Chicago, Illinois
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Leora Aizman
- George Washington University School of Medicine, Washington, DC
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold W Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justine V Cohen
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee Pride
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Marilyn T Wan
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anna A Bar
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Sumaira Aasi
- Department of Dermatology, Stanford Medicine, Stanford, California
| | | | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Straccia P, Martini M, Pierconti F. Pleural metastasis from auricular melanoma: A brief report. Diagn Cytopathol 2020; 48:376-379. [PMID: 31846216 DOI: 10.1002/dc.24370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/07/2022]
Abstract
Primary auricular melanoma is rarely reported. Approximately, it accounts for 1% to 4% of all cutaneous melanoma. Early literature suggested that melanoma of the ear is more aggressive than other melanomas, with a propensity for spreading to both regional lymph nodes and distant sites. Here, we present a case of cytological pleural metastasis from auricular melanoma in a 43-year-old woman. Immunohistochemical staining showed that the tumors cells were positive for S-100 protein and Melan-A. The mutation of the v-raf murine sarcoma viral oncogene homolog B (BRAF)V600E was demonstrated on Sanger sequencing. To our knowledge, this is the first report describing the cytomorphology of metastatic auricular melanoma in pleural effusion.
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Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, Foundation "A. Gemelli" University Hospital, Rome, Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, Foundation "A. Gemelli" University Hospital, Rome, Italy
| | - Francesco Pierconti
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, Foundation "A. Gemelli" University Hospital, Rome, Italy
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3
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Recurrence risk of early-stage melanoma of the external ear: an investigation of surgical approach and sentinel lymph node status. Melanoma Res 2020; 30:173-178. [DOI: 10.1097/cmr.0000000000000534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yamasaki A, Wu MP, Emerick KS. Outcomes of Cartilage-Sparing Wide Local Excision for Primary Melanoma of the External Ear. OTO Open 2020; 4:2473974X20903124. [PMID: 32215354 PMCID: PMC7065503 DOI: 10.1177/2473974x20903124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To describe outcomes after cartilage-sparing wide local excision for primary melanoma of the external ear. Study Design Retrospective analysis of patients undergoing external ear melanoma excision using a cartilage-sparing approach at a university-based tertiary care center between 2010 and 2018. Setting University-based tertiary care center. Subject and Methods Chart 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. Results A 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. Conclusion Cartilage-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.
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Affiliation(s)
- Alisa Yamasaki
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael P. Wu
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin S. Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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National Analysis of Patients With External Ear Melanoma in the United States. J Craniofac Surg 2019; 30:e787-e790. [DOI: 10.1097/scs.0000000000005777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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A Systematic Review of Surgical Management of Melanoma of the External Ear. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1755. [PMID: 29876188 PMCID: PMC5977960 DOI: 10.1097/gox.0000000000001755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/20/2018] [Indexed: 11/26/2022]
Abstract
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.
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Deep NL, Glasgow AE, Habermann EB, Kasperbauer JL, Carlson ML. Melanoma of the external ear: A population-based study. Am J Otolaryngol 2017; 38:309-315. [PMID: 28258767 DOI: 10.1016/j.amjoto.2017.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/31/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Primary melanoma of the external ear (PMEE) is rare and therefore well-suited for large population-based registry analysis. The objective of this study was to utilize the Surveillance, Epidemiology, and End Results (SEER) set of cancer registries to determine the incidence, treatment, and survival characteristics of PMEE. METHODS A retrospective cohort analysis of SEER data from 2004 to 2013 identified all cases of PMEE stage I-IV by AJCC 7th edition guidelines. Population-based incidence was calculated. Cancer-specific survival data by stage was assessed using Kaplan-Meier analysis and the relative effects of tumor characteristics were analyzed with Cox regression models. RESULTS A total of 5481 patients were analyzed (mean age 66.7years, 86.5% male, 93.6% non-Hispanic white). The incidence of PMEE was 1.91 per 100,000 persons-per-year. At diagnosis, 68.1% were stage I, 15.2% were stage II, 4.7% were stage III, 1.5% were stage IV, and 10.8% were unknown. The five-year overall and cancer-specific survival was 78.8% and 90.0%, and, according to AJCC stage, was 85.7% and 95.3% for stage I (n=2287), 64.6% and 81.1% for stage II (n=453), 50.8% and 57.0% for stage III (n=154), 17.2% and 20.5% for stage IV (n=34), and 71.0% and 87.1% for unknown stage (n=330), respectively. The multivariable Cox model identified tumor characteristics that were independently associated with survival. CONCLUSIONS This is the first study to characterize the epidemiology, presentation and outcome of PMEE using the SEER registries. Older age, increasing Breslow thickness, stage, presence of ulceration, positive lymph nodes and distant metastasis each independently predicted time to cancer-specific death.
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Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Amy E Glasgow
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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Toia F, Garbo G, Tripoli M, Rinaldi G, Moschella F, Cordova A. A systematic review on external ear melanoma. J Plast Reconstr Aesthet Surg 2015; 68:883-94. [PMID: 25971418 DOI: 10.1016/j.bjps.2015.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 02/01/2015] [Accepted: 04/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND External ear melanoma accounts for only 1% of all cutaneous melanomas, and data on its optimal management and prognosis are limited. AIM We aim to review the literature on external ear melanoma to guide surgeons in the treatment of this uncommon and peculiar pathology. MATERIALS AND METHODS A systematic review of English language studies on ear melanoma published from 1993 to 2013 was performed using the PubMed electronic database. Data on epidemiology, oncological treatment (tumor resection and regional lymph nodes management), and reconstruction were extrapolated from selected papers. RESULTS The total number of patients was 858 (30 studies). The helix was the most common location (57%); superficial spreading melanoma was the most common histopathological subtype (41%). The mean Breslow thickness was 2.01 mm, with 88% of stage I-II patients. Sentinel lymph node biopsy was performed in 45% of patients, with 8% of positive nodes. Available data on its prognosis are fragmentary and contrasting, but the Breslow thickness appears to be the main prognostic factor. There is a tendency towards reduced resection margins and preservation of the underlying perichondrium and cartilage. Local flaps are the most popular reconstructive option. CONCLUSION To the best of our knowledge, this systematic review presents the largest data series on external ear melanoma. There is no general agreement on its surgical management, but a favorable prognosis seems to justify the tendency towards conservative treatments.
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Affiliation(s)
- Francesca Toia
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
| | - Giuseppe Garbo
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Massimiliano Tripoli
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Gaetana Rinaldi
- Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Moschella
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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10
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McCarty MA, Lentsch EJ, Cerrati EW, Stadelmann WK. Melanoma of the ear: results of a cartilage-sparing approach to resection. Eur Arch Otorhinolaryngol 2013; 270:2963-7. [DOI: 10.1007/s00405-013-2440-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 03/08/2013] [Indexed: 11/24/2022]
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Reconstruction after wide excision of primary cutaneous melanomas: part I—the head and neck. Lancet Oncol 2009; 10:700-8. [DOI: 10.1016/s1470-2045(09)70116-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND In 2005, it is now estimated that one in 62 Americans have a lifetime risk of developing invasive melanoma. Melanoma of the ear accounts for 1% of all cases of melanoma and 14.5% of all head and neck melanomas. With this increase in incidence, plastic surgeons will likely have to treat and manage more of these patients in the future. METHODS A retrospective chart review was performed on 199 patients diagnosed with primary melanoma of the ear. Specimens were reviewed by same center dermatopathologists (Duke University Medical Center, Durham, NC) for standardization of histologic criteria in all but 10 patients. Surgical treatment and outcomes were reviewed and survival rates based on thickness and stage were calculated. Metastases information, anatomic location on the ear, and histologic subtype were recorded and analyzed. RESULTS The median length of follow up was 3.3 years with a range of 0.4 to 24.9 years. Eighty-six patients were known to be dead at the last known follow-up date. The median survival time among these patients was 7.9 years. The most common histologic classification of the lesions were superficial spreading type (45.2%) and were most likely to be localized to the anterior helix (49.3%). One hundred sixty-one of 199 (80.9%) patients underwent wide local excision with local recurrence rate of 10.6%. Overall, 43.2% of patients developed a local recurrence or metastatic spread. Ulceration, thickness, and stage all negatively affected survival. CONCLUSIONS This is the largest review of primary ear melanoma cases reported to date. Survival probabilities at 2, 5, and 10 years for melanoma of the ear based on thickness and stage are presented. Ulceration adversely affected survival probability (P < 0.003). Lesion excision with confirmed negative margins on permanent section pathology should be the goal of initial surgical therapy, and there is no apparent role for elective lymph node dissection in treatment of melanoma of the ear.
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Affiliation(s)
- Adam G Ravin
- Department of Surgery, Division of Plastic, Reconstructive, Oral, and Maxillofacial Surgery, Duke Comprehensive Cancer Center, Durham, NC 27710, USA
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Jahn V, Breuninger H, Garbe C, Moehrle M. Melanoma of the ear: prognostic factors and surgical strategies. Br J Dermatol 2006; 154:310-8. [PMID: 16433802 DOI: 10.1111/j.1365-2133.2005.07065.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ear's specific anatomical and lymphatic characteristics impose special requirements on the treatment of melanoma of the ear. OBJECTIVES The aim of this prospective study was to define prognostic factors for melanoma of the ear and to evaluate surgical strategies for excision margins, histological evaluation and sentinel lymph node biopsy (SLNB) in order to achieve better cosmetic and functional results. PATIENTS AND METHODS One-hundred and sixty-one patients with stage I/II melanoma of the external ear were treated in the Department of Dermatology, University of Tuebingen, from March 1976 to March 2004 (median follow-up 62 months). Malignant melanoma of the external ear represented 3% of the stage I/II cutaneous melanomas and 20% of the stage I/II head and neck melanomas recorded in the Melanoma Registry of the Department of Dermatology at the University of Tuebingen. Twenty of 42 lentigo maligna melanomas (LMM) underwent conventional histological evaluation, 22 underwent complete three-dimensional histology of excision margins (3D histology) in a paraffin-technique, i.e. micrographic surgery. SLNB was performed in 28 patients with melanomas thicker than 1.0 mm. Clinical, histological and surgical risk factors were evaluated by univariate and multivariate analysis. RESULTS The median thickness of the tumours in the present study was 1.08 mm (mean 1.51 mm; range 0.18-8.50 mm), and the median excision margins were 11.0 mm (mean 12.61 mm; range 2.0-31.0 mm). The 3-year disease-specific survival rate was 98%, and the 3-year recurrence-free survival rate was 83%. Tumour thickness and invasion level were the only risk factors significant for disease-specific survival. Tumour thickness, location of the tumour and extent of excision margins were independently significant risk factors for recurrence-free survival. LMMs removed surgically with accompanying 3D histology were thicker than those examined by conventional histology (median 0.93 mm vs. 0.83 mm). The use of surgery with 3D histology, i.e. micrographic surgery, made it possible to reduce the excision margins (median 5 mm vs. 10 mm) without an increased risk of recurrence. Two of 29 SLNBs were positive (6.9%). There were six preregional recurrences after negative SLNB and one after positive SLNB. None of the patients who underwent SLNB died of melanoma-related causes during the observation period. CONCLUSIONS This is the largest series of ear melanomas reported so far. The overall survival depended only on the tumour thickness and Clark level of invasion. Local recurrence was more frequent with smaller excision margins, but this did not influence the overall survival. Smaller excision margins under 3D-histological control did not carry an increased risk of local recurrence. Our results do not permit conclusions regarding the prognostic impact of SLNB for patients with melanoma of the ear.
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Affiliation(s)
- V Jahn
- Department of Dermatology, University of Tuebingen Clinics, Eberhard-Karls-Universität, Liebermeisterstr. 25, D-72076 Tuebingen, Germany
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Mondin V, Rinaldo A, Shaha AR, Cureoglu S, Devaney KO, Suárez C, Ferlito A. Malignant melanoma of the auricle. Acta Otolaryngol 2005; 125:1140-4. [PMID: 16353384 DOI: 10.1080/00016480510038176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Malignant melanomas are found in a variety of locations, ranging from sun-exposed skin to the nasal cavity and paranasal sinuses. Melanomas arising in the head and neck region comprise some 20% of all melanomas; of these, 7-15% occur in the vicinity of the external ear (most often on the helix). Auricular melanomas, like those arising elsewhere, are rare in childhood and are most often first diagnosed in men in their 50s. Melanomas of the external ear may present as flat pigmented lesions or as raised mass lesions; amelanotic (non-pigmented) variants exist as well. Auricular melanomas are frequently recognized pathologically as either superficial spreading melanomas or nodular melanomas. These tumors are aggressive, with a propensity for spreading to both regional lymph nodes and distant sites. Key pathologic prognostic features of auricular melanomas include the histological subtype, tumor thickness, level of invasion and presence of ulceration. Therapy includes both aggressive surgical attempts at excision in combination with sentinel node sampling in some instances and perhaps, adjuvant therapy as well. This is a tumor which is often overlooked until late in its course, with tragic consequences; vigilance and aggressive attempts at identifying these tumors at earlier stages are strongly advocated.
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Affiliation(s)
- Vanni Mondin
- Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
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Devaney KO, Boschman CR, Willard SC, Ferlito A, Rinaldo A. Tumours of the external ear and temporal bone. Lancet Oncol 2005; 6:411-20. [PMID: 15925819 DOI: 10.1016/s1470-2045(05)70208-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Symptoms such as hearing impairment, tinnitus, or a disturbance in sense of balance can generally be attributed to non-neoplastic causes, such as otitis media, otosclerosis, or trauma. Less commonly, auricular signs and symptoms are the result of non-neoplastic and neoplastic space-occupying lesions. The external ear can be the site of development of squamous carcinomas and basal-cell carcinomas; the middle ear and inner ear can host metastatic deposits, and primary squamous carcinomas and adenocarcinomas. Most auricular malignant diseases occur in adulthood; only the rhabdomyosarcomas of the middle ear arise in children. Most malignant diseases of the auricular apparatus are treated by a combination of surgery (commonly including radical excision of temporal bone), radiotherapy, and chemotherapy.
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Pockaj BA, Jaroszewski DE, DiCaudo DJ, Hentz JG, Buchel EW, Gray RJ, Markovic SN, Bite U. Changing surgical therapy for melanoma of the external ear. Ann Surg Oncol 2003; 10:689-96. [PMID: 12839855 DOI: 10.1245/aso.2003.09.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic variables and clinical ramifications of melanoma of the ear. METHODS A retrospective chart review of patients treated since 1985 at the Mayo Clinic in Scottsdale, AZ, and Rochester, MN, identified 78 patients with complete follow-up. RESULTS Of these 78 patients, 68 (87%) were men; the mean age was 64 years (range, 23-87 years). Melanoma thickness averaged 1.7 mm (range,.2-7.0 mm). Treatment of the primary melanoma included wedge resection (59%), Mohs resection (14%), partial amputation (11%), skin and subcutaneous resection with perichondrium preservation (9%), and total amputation (7%). Nineteen patients underwent an elective lymph node dissection, and lymph node metastases were found in seven (37%). Two patients presented with clinically positive lymph nodes. Sentinel lymph node biopsy was performed in 10 patients. After a mean follow-up of 55.7 months, 10 patients (13%) had local recurrence, 9 patients (12%) had regional recurrence, and systemic metastases had developed in 17 patients (22%). Tumor thickness, lymph node metastases, and local recurrence significantly affected systemic recurrence. CONCLUSIONS The treatment of malignant melanoma of the external ear should follow current standard guidelines, which require wide local excision with negative margins. Sentinel lymph node biopsy can be used to identify patients with lymph node metastases who are at high risk of recurrence.
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Affiliation(s)
- Barbara A Pockaj
- Department of Surgery, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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