title: Extracellular and intracellular melanin in inflammatory middle ear disease.
abstract: OBJECTIVE
  Melanin is a pigmented polymer with a known role in dermal solar protection. In vertebrates, melanogenesis has been reported in leukocyte populations, suggesting a potential role in innate immunity. In this study, we report the novel finding of melanin associated with chronic inflammation and speculate on its potential role in the middle ear and mastoid.
  
  
  METHODS
  Retrospective review of case series.
  
  
  METHODS
  Medical records of six patients who demonstrated melanin in the ear were reviewed.
  
  
  RESULTS
  Six patients from 1 to 63 years of age were identified with extracellular melanin and melanin-laden histiocytes within the middle ear and/or mastoid air cells at time of surgery. Concurrent intraoperative findings included cholesteatoma (n = 3), chronic suppurative otitis media (n = 2), and coalescent mastoiditis (n = 1). Histologically, extracellular melanin and melanin-laden histiocytes were identified by Fontana-Masson stain; absence of melanocytes was confirmed by the absence of Melan-A staining. One patient had a positive stain for CD163 (a marker for macrophages).
  
  
  CONCLUSIONS
  This case series is the first demonstration of melanin within middle ear mucosa without melanocytes in immediate proximity or metastatic melanocytic lesions. Melanin's presence in the setting of inflammation suggests that there may be a heretofore unreported link between the pigmentary and immune systems in the middle ear.
  
  
  METHODS
  4.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fritz
authors.forename: Pamela C
authors.initials: PC
authors.lastname: Roehm
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bannan
authors.forename: Anil K
authors.initials: AK
authors.lastname: Lalwani
mesh_terms: D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D045604:Extracellular Fluid / Q000378:metabolism*; D005260:Female; D006644:Histiocytes / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D018836:Inflammation Mediators / Q000378:metabolism*; D007424:Intracellular Fluid / Q000378:metabolism*; D008297:Male; D008417:Mastoiditis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D008543:Melanins / Q000032:analysis / Q000378:metabolism*; D008875:Middle Aged; D010033:Otitis Media / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D018836:Inflammation Mediators; D008543:Melanins