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

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.

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

“…The incidence of cutaneous melanoma in general has risen over the past decade, and this trend has also been noted for melanoma of the external ear [3]. According to our epidemiologic data it typically affects males in the 7 th decade of life [4,5]. The difference in incidence by sex has been attributed to the fact that women traditionally have longer hair which serves a protective role [6].…”

Auricular and periauricular melanomas have similar clinicopathologic factors and survival rates

“…Furthermore, they are usually associated with early stage 2,6–8 and lower Breslow thickness 2,5,6,8 . The anatomical location of the tumor was concluded to have no impact on disease relapse and outcome; however, other variables such as older age, advanced clinical stage, increasing tumor thickness, presence of ulceration, lymph node involvement, and systemic dissemination are considered independent and adverse prognostic indicators of survival 1–5,7,8 …”

“…In the literature, controversial reports regarding clinical behaviors of these malignancies have been published; some suggest that these tumors are aggressive with a propensity for metastasis that renders radical surgical approaches 3 . However, other reports did not conclude such unfavorable clinical behaviors for ear melanomas compared with other regions 2,4,6,7 . In this study, we investigated the clinical behaviors of the melanomas arising in the external ear and compared them with those arising in periauricular regions.…”

“…3 However, other reports did not conclude such unfavorable clinical behaviors for ear melanomas compared with other regions. 2,4,6,7 In this study, we investigated the clinical behaviors of the melanomas arising in the external ear and compared them with those arising in periauricular regions.…”

“…Melanomas of the ear are rare malignancies; they comprise about 1% of all cutaneous melanomas and 10% of melanomas arising in the head and neck regions. [1][2][3][4][5] Similar to melanomas arising in other regions, surgical excision is the primary treatment for these patients. 4 In the literature, controversial reports regarding clinical behaviors of these malignancies have been published; some suggest that these tumors are aggressive with a propensity for metastasis that renders radical surgical approaches.…”