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Annals of Surgical Oncology 10:689-696 (2003)
© 2003 Society of Surgical Oncology

ORIGINAL ARTICLES

Changing Surgical Therapy for Melanoma of the External Ear

Barbara A. Pockaj, MD, Dawn E. Jaroszewski, MD, David J. DiCaudo, MD, Joseph G. Hentz, MS, Edward W. Buchel, MD, Richard J. Gray, MD, Svetomir N. Markovic, MD and Uldis Bite, MD

From the Department of Surgery (BAP, DEJ, RJG), Department of Dermatology (DJD), Section of Biostatistics (JGH), and Division of Plastic and Reconstructive Surgery (EWB), Mayo Clinic, Scottsdale, Arizona; and the Division of Medical Oncology (SNM) and the Division of Plastic and Reconstructive Surgery (UB), Mayo Clinic, Rochester, Minnesota.

Correspondence: Address correspondence and reprint requests to: Barbara A. Pockaj, MD, Department of Surgery, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259; E-mail: pockaj.barbara{at}mayo.edu

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.

Key Words: Ear • Elective lymph node dissection • Malignant melanoma • Prognosis • Sentinel lymph node biopsy • Wide local excision






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Copyright © 2003 by the Society of Surgical Oncology.