title: A systematic review on external ear melanoma.
abstract: BACKGROUND
  External ear melanoma accounts for only 1% of all cutaneous melanomas, and data on its optimal management and prognosis are limited.
  
  
  OBJECTIVE
  We aim to review the literature on external ear melanoma to guide surgeons in the treatment of this uncommon and peculiar pathology.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy. Electronic address: francescatoia@gmail.com.
authors.forename: Francesca
authors.initials: F
authors.lastname: Toia
authors.affiliation: Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garbo
authors.affiliation: Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Tripoli
authors.affiliation: Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Gaetana
authors.initials: G
authors.lastname: Rinaldi
authors.affiliation: Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Moschella
authors.affiliation: Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Cordova
mesh_terms: D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D004431:Ear, External / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D000096142:Cutaneous Malignant Melanoma
keywords: Ear melanoma; External ear; Melanoma; Melanoma treatment