Recurrence risk of early-stage melanoma of the external ear: an investigation of surgical approach and sentinel lymph node status

Cartilage Resection in the Surgical Management of Ear Melanoma

BACKGROUND

Melanoma of the ear accounts for approximately 1% of cutaneous melanomas. Management recommendations are based on small retrospective series and case reports. Resection of melanoma of the ear requires a delicate balance between disease clearance, preservation of function, and aesthetics. The role of cartilage resection in the wide excision of melanoma of the ear remains unclear. We aimed to compare outcomes in patients having wide excision of ear melanoma who had cartilage resected with those who had a cartilage-sparing approach.

METHODS

Data were obtained from the Melanoma Institute Australia (MIA) prospectively maintained database. All patients diagnosed with invasive melanoma involving the ear between 1990 and 2022 were included. Data analysis was performed to assess the association between cartilage resection and recurrence-free survival (RFS), melanoma-specific survival (MSS), and overall survival (OS).

RESULTS

Overall, 411 patients were included in the study, of whom 330 (80%) had cartilage resected and 81 (20%) had a cartilage-sparing resection. The cartilage resection group had a higher mean Breslow thickness (1.9 vs. 1.4 mm; p = 0.0002), whereas the cartilage-sparing group had a higher proportion of stage IA disease (60.5 vs. 39.7%; p = 0.041). Five (1.2%) patients had melanoma invading into perichondrium but not deeper. Cartilage resection had no impact on RFS {hazard ratio [HR] 0.82 (0.52-1.29); p = 0.39} or MSS (HR 0.89 (0.30-2.62); p = 0.83).

CONCLUSION

The decision to resect cartilage as part of the wide excision of invasive ear melanoma should be tailored to the needs of the individual patient, however a cartilage-sparing approach does not appear to compromise MSS outcomes, particularly in early-stage disease.

Gastric metastasis from nodular malignant melanoma of the auricle with multigene aberrations: A rare case report and literature review

Primary malignant melanoma (MM) of the external ear accounts for a low proportion of cases of cutaneous MM, and its incidence in non-white women is very low. The stomach is a rare metastatic site for MM. Gastric metastasis of MM of the external ear is extremely rare, and the associated gene alterations and mechanisms are poorly understood. The present report describes the case of a 58-year-old Asian woman who had a mass on the left auricle for 5 years and was diagnosed with nodular MM with the BRAF V600E mutation after surgical resection. Postoperative metastases to the stomach and descending duodenum appeared 1 year after resection. After 11 months of BRAF-targeted therapy and immunotherapy, the patient developed drug resistance and died from systemic metastases to the brain, lungs, liver, left adrenal gland and peritoneum. Genetic testing revealed additional aberrations in MYB, p16, MYC and PTEN. The clinical characteristics of MM of the external ear and gastric metastatic MM were also summarized through a retrospective literature review. Immunohistochemical staining is critical in the diagnosis of gastric metastasis from MM of the external ear. This disease often requires a multidisciplinary treatment approach, including surgery, targeted therapy and immunotherapy. The present study provides some genetic information about this rare disease and discusses appropriate treatment strategies. The findings of the present study suggests that the surgical margin size, tumor histological type and number of genetic aberrations may be closely associated with metastasis potential, therapeutic efficacy and patient outcome.

Immediate Ear Lobule Reconstruction After Melanoma Resection

EAR LOBULE RECONSTRUCTION

Cancer removal from aesthetically vulnerable areas of the face strikes a delicate balance between oncologically appropriate excision and preservation of a unique structure. A 72-year-old male presented with melanoma of the right earlobe requiring complete excision. Partial or complete absence of an ear causes a deformity and is difficult to conceal. Thus, lobule reconstruction postmelanoma excision eliminates deformity and aids in psychological recovery. In this case report, we describe our novel technique of a 2-stage lobule reconstruction immediately after melanoma resection using a direct template of the excised lobule. This template allowed us to sculpt its identical size and shape using harvested contralateral conchal cartilage graft. After the cartilage was banked in a subcutaneous pocket for 8.5 weeks, the second stage liberated the reconstructed lobule. This immediate 2-stage technique eliminated a period of soft tissue contracture and presented a rare surgical opportunity to recreate a structure using its direct template.

LEVEL OF EVIDENCE

Level IV-case report.

Factors influencing locoregional recurrence and distant metastasis in Asian patients with cutaneous melanoma after surgery: A retrospective analysis in a tertiary hospital in Taiwan

BACKGROUND

The goal of this study was to investigate the prognostic factors for locoregional recurrence and metastasis in patients with cutaneous melanoma (CM) who underwent surgery, especially in the acral lentiginous melanoma (ALM) subtype.

METHODS

This study was a retrospective review of patients who underwent surgery for CM at Taipei Veterans General Hospital between 2000 and 2018. We investigated the risk factors for locoregional and distant metastases. The association between clinicopathological factors and locoregional recurrence and distant metastasis of the CM and ALM subtypes was analyzed. In addition, the outcomes between the ALM and non-ALM groups were compared.

RESULTS

A total of 161 patients were included in the analysis. The most common histological subtype was ALM. The overall locoregional recurrence rate of CM was 13.0% and the distant metastasis rate was 42.9%, whereas that of the ALM subtype was 12.5% and 45.5%, respectively. In patients with CM, male sex, tumor with lymphovascular invasion, and positive lymph node status were the prognostic factors for both locoregional recurrence and distant metastasis. Among the patients with ALM, positive lymph node status was significantly associated with both locoregional recurrence and distant metastasis.

CONCLUSION

In this cohort, factors influencing locoregional recurrence and distant metastasis were similar between the ALM and non-ALM groups. The above-recommended surgical margin did not show any benefit in either the CM or the ALM subtype. ALM can be handled using the same surgical strategy as CM in the Asian population.