Review
A systematic review on external ear melanoma

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Summary

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.

Introduction

External ear melanomas are relatively rare, representing approximately 1% of all cutaneous melanomas.1 A limited number of papers address this topic, and most of them include a small number of patients.2, 3, 4, 5, 6, 7, 8, 9

The external ear presents peculiar characteristics with respect to anatomy and lymphatic drainage: the presence of a thin skin and of a cartilaginous framework requires a specific approach for tumor resection and reconstruction; lymphatic drainage – as for other head and neck regions – is unpredictable and often reaches multiple basins.4, 9

Furthermore, there is no agreement on the biological behavior of melanoma of this region: some authors claim a better prognosis and propose less invasive treatments,8, 9 while others consider external ear melanoma more aggressive.2 As a consequence, its treatment is not standardized, which often differs from standard treatment for melanomas of other regions.10

The aim of this study was to review the literature on the epidemiology and surgical treatment of external ear melanoma in order to provide guidelines for its clinical management.

Section snippets

Search methodology

A systematic review of the studies on ear melanoma was performed using the PubMed electronic database. Initial keywords included “ear melanoma.” Extended search using the Medical Subject Headings (MeSH) terms “malignant melanoma” and “ear” and the keywords “melanoma pinna” and “melanoma ear reconstruction” was performed.

A review of abstracts was performed on articles published from 1993 to 2013. The year 1993 was chosen as a starting point because of the introduction of sentinel lymph node

Results and discussion

The initial search returned 448 papers; an extended search did not return any additional reference. Four hundred and ten papers were excluded and 38 papers were selected based on abstract review; four further papers were excluded because we were not able to find them despite consulting the archives of other institutions as well. Thirty-four full-length papers were reviewed and four further articles were excluded based on the lack of basic data. A total of 30 papers were eventually selected for

Conclusions

This systematic review provides epidemiological data on the distribution, location, and histological characteristics of external ear melanomas.

It also highlights the lack of agreement on the surgical management of ear melanoma. The available literature does not allow drawing of clinical guidelines, but it only summarizes the most common approach to tumor excision, lymph node management, and reconstruction, based on authors' opinions rather than on scientific evidence:

  • -

    Tumor excision: For Tis and

Conflict of interest

None.

Funding

None.

Ethical approval

N/A.

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