Pigmented lesion on the ear

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Pigmented lesion on the ear

J Fam Pract. 2004 July;53(7):541-544

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References

1. Pockaj BA, Jaroszewski DE, DiCaudo DJ, et al. Changing surgical therapy for malignant melanoma of the external ear. Ann Surg Oncol 2003;10:689-696.

2. Swetter SM. Malignant melanoma. EMedicine 2003. Available at www.emedicine.com/derm/topic257.htm. Accessed on May 10, 2004.

3. Zalaudek I, Ferrara G, Argenziano G, et al. Diagnosis and treatment of cutaneous melanoma: a practical guide. SKINmed 2003;2:20-31.

4. Benmeir P, Baruchin A, Weinberg A. Rare sites of melanoma: melanoma of the external ear. J Craniomaxillofac Surg 1995;23:50-53.

5. Batsakis JG. Melanomas (cutaneous and mucosal) of the head and neck. In: Tumors of the Head and Neck: Clinical and Pathological Considerations. 2nd ed. Baltimore, Md, and London: Williams & Wilkins; 1980;431-447.

6. Byers RM, Smith JL, Russell N, et al. Malignant melanoma of the external ear. Review of 102 cases. Am J Surg 1980;140:518-521.

7. Davidsson A, Hellquist HB, Villman K, et al. Malignant melanoma of the ear. J Laryngol Otol 1993;107:798-802.

8. Hudson DA, Krige JEJ, Strover RM, et al. Malignant melanoma of the external ear. Br J Plast Surg 1990;43:608-611.

9. Eedy DJ. Surgical treatment of melanoma. Br J Dermatol 2003;149:2-12.

10. Lens MB, Dawes M, Goodacre T, et al. Excision margins in the treatment of primary cutaneous melanoma. A systemic review of randomized controlled trials comparing narrow vs. wide excision. Arch Surg 2002;137:1101-1105.

11. Narayan D, Ariyan S. Surgical considerations in the management of malignant melanoma of the ear. Plast Reconstr Surg 2001;107:20-24.

12. Wey PD, De La Cruz C, Goydos JS, et al. Sentinel lymph node mapping in melanoma of the ear. Ann Plast Surg 1998;40:506-509.

Lymph node dissection

Elective lymph node dissection, as well as superficial parotidectomy in cases with suspected metastasis, have been performed; however, sentinel lymph node mapping can drastically reduce the morbidity associated with unnecessary lymph node dissection.¹² This technique has been shown to be of benefit in managing malignant melanoma of the ear due to its highly ambiguous and variable lymphatic drainage patterns.¹²

Sentinel node biopsy of the parotid gland can be performed as well with low morbidity and a high success rate.¹ Byers et al⁶ suggested that neck dissections be reserved for patients with Clark level IV or V melanomas.

Immunotherapies

Immunotherapeutic agents, including interleukin-2 and interferon alpha 2b, have recently become significant adjuvant therapies for malignant melanoma, and investigation into a potential melanoma vaccine is currently underway.³ Consultations with surgical, medical, and possibly radiation oncology, nuclear medicine, and pathology may be needed in treating patients with malignant melanoma depending on tumor invasiveness and metastasis.

Evidence of metastatic spread should routinely be sought when examining patients. For patients with lesions <1 mm thick, close follow-up with biannual full-body skin examination is recommended for 2 years following excision, and subsequently each year for the next 8 years.³ Melanomas thicker than 1 mm may require up to 4 annual visits during the first 2 years, followed by biannual and annual exams. Chest x-ray is recommended annually during the first 5 years for lesions <3 mm thick, and biannually for those >3 mm thick.³

The patient’s follow-up

Our patient’s lesion was very superficial. Following excisional biopsy, a wedge excision with appropriate 10-mm margins was performed by a plastic surgeon. The result of the chest x-ray was normal. The patient is scheduled for follow-up examination every 6 months for 2 years and yearly thereafter.

Corresponding author
Amor Khachemoune, MD, CWS, Georgetown University Medical Center, Division of Dermatology, 3800 Reservoir Road, NW, 5PHC, Washington, DC 20007. E-mail: amorkh@pol.net.

Pigmented lesion on the ear

References

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