|
Malignant melanoma of the pinna. Importance of its
diagnosis, treatment and prognostic factors.An
Otorrinolaringol Ibero Am. 2006;33(6):545-50.
About 25%-30%
of the primary malignant melanomas occur in the head and neck region
and of these less than 10% arise on the external ear, mainly on
helix and the lobule of the pinna. Melanoma thickness and nodal or
distant metastases are advers factors for its prognosis. We report a
case of a tumor that affected the right pinna and was removed by our
ENT, department with good evolution, being the patient free of
disease after 5 years follow-up.
Melanoma of the
ear: treatment and survival probabilities based on 199 patients.Ann
Plast Surg. 2006 Jul;57(1):70-6.
BACKGROUND: In
2005, it is now estimated that one in 62 Americans have a lifetime
risk of developing invasive melanoma. Melanoma of the ear accounts
for 1% of all cases of melanoma and 14.5% of all head and neck
melanomas. With this increase in incidence, plastic surgeons will
likely have to treat and manage more of these patients in the
future. METHODS: A retrospective chart review was performed on 199
patients diagnosed with primary melanoma of the ear. Specimens were
reviewed by same center dermatopathologists (Duke University Medical
Center, Durham, NC) for standardization of histologic criteria in
all but 10 patients. Surgical treatment and outcomes were reviewed
and survival rates based on thickness and stage were calculated.
Metastases information, anatomic location on the ear, and histologic
subtype were recorded and analyzed. RESULTS: The median length of
follow up was 3.3 years with a range of 0.4 to 24.9 years.
Eighty-six patients were known to be dead at the last known
follow-up date. The median survival time among these patients was
7.9 years. The most common histologic classification of the lesions
were superficial spreading type (45.2%) and were most likely to be
localized to the anterior helix (49.3%). One hundred sixty-one of
199 (80.9%) patients underwent wide local excision with local
recurrence rate of 10.6%. Overall, 43.2% of patients developed a
local recurrence or metastatic spread. Ulceration, thickness, and
stage all negatively affected survival. CONCLUSIONS: This is the
largest review of primary ear melanoma cases reported to date.
Survival probabilities at 2, 5, and 10 years for melanoma of the ear
based on thickness and stage are presented. Ulceration adversely
affected survival probability (P < 0.003). Lesion excision with
confirmed negative margins on permanent section pathology should be
the goal of initial surgical therapy, and there is no apparent role
for elective lymph node dissection in treatment of melanoma of the
ear.
Melanoma of the
ear: prognostic factors and surgical strategies.Br
J Dermatol. 2006 Feb;154(2):310-8.
BACKGROUND: The
ear's specific anatomical and lymphatic characteristics impose
special requirements on the treatment of melanoma of the ear.
OBJECTIVES: The aim of this prospective study was to define
prognostic factors for melanoma of the ear and to evaluate surgical
strategies for excision margins, histological evaluation and
sentinel lymph node biopsy (SLNB) in order to achieve better
cosmetic and functional results. PATIENTS AND METHODS: One-hundred
and sixty-one patients with stage I/II melanoma of the external ear
were treated in the Department of Dermatology, University of
Tuebingen, from March 1976 to March 2004 (median follow-up 62
months). Malignant melanoma of the external ear represented 3% of
the stage I/II cutaneous melanomas and 20% of the stage I/II head
and neck melanomas recorded in the Melanoma Registry of the
Department of Dermatology at the University of Tuebingen. Twenty of
42 lentigo maligna melanomas (LMM) underwent conventional
histological evaluation, 22 underwent complete three-dimensional
histology of excision margins (3D histology) in a
paraffin-technique, i.e. micrographic surgery. SLNB was performed in
28 patients with melanomas thicker than 1.0 mm. Clinical,
histological and surgical risk factors were evaluated by univariate
and multivariate analysis. RESULTS: The median thickness of the
tumours in the present study was 1.08 mm (mean 1.51 mm; range
0.18-8.50 mm), and the median excision margins were 11.0 mm (mean
12.61 mm; range 2.0-31.0 mm). The 3-year disease-specific survival
rate was 98%, and the 3-year recurrence-free survival rate was 83%.
Tumour thickness and invasion level were the only risk factors
significant for disease-specific survival. Tumour thickness,
location of the tumour and extent of excision margins were
independently significant risk factors for recurrence-free survival.
LMMs removed surgically with accompanying 3D histology were thicker
than those examined by conventional histology (median 0.93 mm vs.
0.83 mm). The use of surgery with 3D histology, i.e. micrographic
surgery, made it possible to reduce the excision margins (median 5
mm vs. 10 mm) without an increased risk of recurrence. Two of 29
SLNBs were positive (6.9%). There were six preregional recurrences
after negative SLNB and one after positive SLNB. None of the
patients who underwent SLNB died of melanoma-related causes during
the observation period. CONCLUSIONS: This is the largest series of
ear melanomas reported so far. The overall survival depended only on
the tumour thickness and Clark level of invasion. Local recurrence
was more frequent with smaller excision margins, but this did not
influence the overall survival. Smaller excision margins under
3D-histological control did not carry an increased risk of local
recurrence. Our results do not permit conclusions regarding the
prognostic impact of SLNB for patients with melanoma of the ear.
Auricular malignant melanoma of early childhood: the role of
sentinel node biopsy.Int
J Pediatr Otorhinolaryngol. 2004 Oct;68(10):1345-8.
Pediatric
melanoma is a rare but lethal disease. These tumors tend to present
at more advanced stages when compared to adult cases. Additionally,
the inability to obtain accurate diagnosis often further delays the
onset of treatment. Here, we present two cases of auricular melanoma
in 3-year-old patients that were biopsied by the shave method prior
to referral to an otolaryngologist. With the staging of the disease
in question, sentinel lymph node biopsy were completed. Case 1
demonstrated positive sentinel nodes and underwent subsequent
modified neck dissection. The second patient with negative sentinel
nodes required no further surgery. Both patients remain disease free
currently, at 16 and 22 months after the sentinel node biopsy. By
discussing our experience and reviewing the current literature, we
hope to shed some light in the diagnosis, staging and treatment of
pediatric melanoma of the head and neck.
External ear
melanoma.Acta
Otorrinolaringol Esp. 2003 Feb;54(2):89-93.
Cutaneous
melanomas are the tumours that have increased more their incidence
in the last fifty years. Melanomas arising from the external
auditory canal are extraordinariously unfrequent. These tumours show
an aggressive and silent behaviour, and due to this the diagnosis is
frequently made in an advanced stage. A male with a malignant
melanoma arising from his left external auditory canal was attended
in our department, suspecting an epidermoid carcinoma. The clinical
findings and the extension of the lesion required a lateral temporal
bone resection, parotidectomy and neck dissection to achieve a total
resection. We present a review of the literature about this entity
and an analysis of the incidence, significance of the lymph node
metastases and value of the elective neck dissection.
Malignant melanoma of external ear: 14 cases report.Lin
Chuang Er Bi Yan Hou Ke Za Zhi. 1999 Jul;13(7):315-6.
OBJECTIVE: To
improve the diagnosis and treatment level of malignant melanoma in
external ear. METHOD: 14 cases with malignant melanoma of external
ear were reported. All patients were treated by surgical excision.
RESULT: 13(in 14) cases were followed up. 7 patients were survival
with no tumor, the others died. The 5-year survival rate for the
whole series was 50.0%. CONCLUSION: The malignant melanoma of
external ear has rapid progress and poor prognosis, early detection
and treatment are necessary. Extensive excision of malignant
melanoma was principle method of the treatment. Recurrent tumor
should be treated by combined operation with radiation.
Malignant
melanoma of the external auditory canal.Am
J Clin Oncol. 1998 Feb;21(1):28-30.
Malignant
melanoma of the ear, other than the pinna, rarely occurs. This is
the first report of a melanoma confined to the external auditory
canal. The case presented is of a 75-year-old man with a malignant
melanoma confined to the external auditory canal. Excision of the
tumor and surrounding lymphatics was accomplished with a lateral
temporal bone resection, superficial parotidectomy, and selective
neck dissection. The patient initially refused postoperative
radiation therapy. Histologic evaluation documented a 17-mm thick
malignant melanoma. All margins were clear and none of the nodes was
positive. Eight months later, he returned with local, regional, and
distant recurrence. Despite attempts at salvage with external
radiation, brachytherapy, and chemotherapy, he died 13 months
postoperatively with widespread disease. Melanoma confined to the
external auditory canal has not been previously reported. A 17-mm
thick melanoma carries a dismal prognosis. Despite initial negative
surgical margins and lack of regional metastases, this patient
developed a rapid, widespread pattern of recurrence.
|
