title: Changing surgical therapy for melanoma of the external ear.
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.
authors.affiliation: Department of Surgery, Mayo Clinic, Scottsdale, Arizona 85259, USA. pockaj.barbara@mayo.edu
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Jaroszewski
authors.forename: David J
authors.initials: DJ
authors.lastname: DiCaudo
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Hentz
authors.forename: Edward W
authors.initials: EW
authors.lastname: Buchel
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
authors.forename: Svetomir N
authors.initials: SN
authors.lastname: Markovic
authors.forename: Uldis
authors.initials: U
authors.lastname: Bite
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004431:Ear, External / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome