Surgical considerations in the management of malignant melanoma of the ear

Malignant melanomas of the external ear are rare and are difficult lesions to treat because of the cosmetic importance and the reconstructive difficul ty of their location. The literature suggests that these lesions hare a wor se prognosis than melanomas occurring elsewhere and that radical resection is the "correct" treatment. To clarify this issue, we examined 21 consecuti ve patients (19 male, 2 female) with malignant melanoma of the ear seen at the Yale-New Haven Hospital over the last 10 years. Nineteen patients had a diagnosis of primary malignant melanoma of the ear, one had a local recurr ence. and one had an in-transit melanoma from an unknown primary site. The mean thickness of the lesions was 2.7 mm. Two patients had palpable nodes, which in both cases turned out to be histologically positive for tumor. All patients underwent local excision and reconstruction using chondrocutaneou s or fasciocutaneous flaps or skin grafts. There was one local recurrence ( 0.5 mm original thickness); there were two patients with regional recurrenc es, both of whom died within a year with disseminated disease. Forty-three percent have been followed for 5 or more years and all are alive and free o f disease. This suggests that malignant melanoma of the eat may be safely t reated by conservative excision and reconstruction.