Mucosal melanoma of the middle ear cavity and Eustachian tube: a case report, literature review, and focus on surgical technique.
OBJECTIVE
To present a case of mucosal melanoma of the Eustachian tube with a focus on surgical technique and to review the literature on treatment of mucosal melanoma of the head and neck, and review cases involving the middle ear and/or Eustachian tube.


METHODS
A 67-year-old man was diagnosed with mucosal melanoma of the middle ear and Eustachian tube.


METHODS
The patient underwent primary surgical resection including transtemporal/transpetrosal approach, endoscopic nasopharyngectomy, infratemporal fossa dissection, temporomandibular joint resection, ipsilateral neck dissection (levels II-IV), and superficial parotidectomy.


RESULTS
The patient was discharged on postoperative Day 7 with a very good functional status. He did have early dysphagia and dysarthria as a result of the VII to XII anastomosis for facial nerve reconstruction, which did require PEG tube placement. However, at 4 months after surgery, the patient was eating solid foods and returning to normal activities. He received radiation therapy postoperatively. There has been no evidence of tumor recurrence at 8 months after treatment.


CONCLUSIONS
The standard treatment of head and neck mucosal melanoma is primarily surgical. Surgical removal of mucosal melanoma in the Eustachian tube/middle ear can present challenges in achieving microscopically negative margins. However, gross tumor resection with postoperative radiotherapy has been shown to improve locoregional control.
Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana 70112, USA.
Geoffrey
G
Peters
Moises A
MA
Arriaga
Daniel W
DW
Nuss
Anna M
AM
Pou
Michael
M
DiLeo
Kelly
K
Scrantz
D000368:Aged; D003131:Combined Modality Therapy; D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D004432:Ear, Middle / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy; D005064:Eustachian Tube / Q000473:pathology / Q000601:surgery*; D005154:Facial Nerve / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006314:Hearing Loss, Conductive / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008416:Mastoid / Q000601:surgery; D008866:Microsurgery; D037981:Neck Dissection; D013506:Otologic Surgical Procedures / Q000379:methods*; D010348:Patient Care Team; D018227:Sarcoma, Clear Cell / Q000473:pathology / Q000601:surgery*; D013704:Temporomandibular Joint / Q000601:surgery; D016896:Treatment Outcome; D014433:Tympanoplasty