title: The perichondrium in auricular melanomas: implications for surgical management.
abstract: OBJECTIVE
  Auricular melanomas are now considered less aggressive than originally thought, but those located on the conchal bowl and posterior ear can create particular challenges for reconstruction. Given the paucity of cases, no standardized recommendations exist for tumor resection. In this study, we provide a pathologic basis in support of conservative tumor resection along the perichondrial plane.
  
  
  METHODS
  Case series with review of pathology and medical records.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  We retrospectively reviewed all ear melanomas from the archives of Yale Dermatopathology and Surgical Pathology laboratories between 1987 and 2009. Cases of melanoma in situ or malignant melanoma of the earlobe were excluded.
  
  
  RESULTS
  Fifty-one cases were included in the study. Patients' age ranged from 26 to 94 years, with a mean (SD) of 58.9 (17.5) years. The male to female ratio was of 5.4:1. Melanomas were distributed similarly between right and left ears, at 52% and 48%, respectively. The most common location was the helix (74.5%). The Breslow depth ranged from 0.19 to 11 mm, with a mean (SD) of 1.64 (1.6) mm. The lesion-perichondrium distance ranged from 0 to 8.12 mm, with a mean (SD) of 1.11 (1.1) mm. Notably, the perichondrium was not invaded in any of the cases.
  
  
  CONCLUSIONS
  Based on the histopathologic characteristics of our cases, the perichondrium can be considered an effective barrier and therefore a biological plane for wide local resection in some cases of auricular melanomas, allowing surgeons to achieve negative margins without necessarily sacrificing underlying cartilage.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut 06520-8062, USA.
authors.forename: E Stirling
authors.initials: ES
authors.lastname: Craig
authors.forename: Priyadharsini
authors.initials: P
authors.lastname: Nagarajan
authors.forename: Esther S
authors.initials: ES
authors.lastname: Lee
authors.forename: Rossitza
authors.initials: R
authors.lastname: Lazova
authors.forename: Jordan
authors.initials: J
authors.lastname: Terner
authors.forename: Deepak
authors.initials: D
authors.lastname: Narayan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004425:Ear Cartilage / Q000033:anatomy & histology*; D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D004431:Ear, External; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies