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Little information has been published on experience with surgical treatment of malignant melanoma of the external ear. Review of the literature and four representative cases admitted to the Wadsworth VA Hospital between 1947 and 1967 provides a basis for therapeutic recommendations. Elective neck dissections are advocated because approximately 40% of melanoma patients treated by local excision alone eventually will develop regional node metastases and because of the high incidence of microscopic malignancy in clinically negative neck dissection specimens. Earlier diagnosis and treatment by surgeons who apply the established principles of radical surgery for cancer can result in improved surviyal rates as demonstrated by our 19‐year survival of stage II melanoma treated by amputation of the affected auricle in continuity with a radical neck dissection.

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A prospective study of patients undergoing major head and neck cancer surgery was undertaken to define the value of preoperative and intraoperative cultures in identifying the patient at "high risk" of wound infection and in predicting the bacteriology of wound infection. One or two days before surgery, the skin of the operative site on the neck, the oropharynx and anterior nares were swabbed. an intraoperative wound culture was obtained after the pharyngeal defect was closed and the wound irrigated with water. All cultures were processed for aerobes in the Anaerobic Bacteriology Research Laboratory at Wadsworth Hospital Center. Wound infections developed in 10 of 31 patients who received cefazolin prophylactically and 21 of 25 patients who received no perioperative antibiotics. Fifty-five percent of infected patients and 68% of noninfected patients demonstrated potential pathogens preoperatively. A potential pathogen isolated preoperatively or intraoperatively was subsequently recovered from 35% of infected wounds. The majority of infected wound cultures grew one or more additional pathogens. A poor correlation was also noted between preoperative nasal Staphylococcus aureus isolation and subsequent recovery from wound infections. We conclude that preoperative and intraoperative aerobic wound cultures are not predictive of the "high risk" patient or of the bacteriology of subsequent wound infection in major head and neck cancer surgery.