Melanoma of the ear: prognostic factors and surgical strategies

Abstract

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.

A systematic review on external ear melanoma

“…According to the literature, other significant prognostic factors for survival or recurrence rate are as follows: Clark level, 6,12 SLN positivity, clinically positive nodes, 6,13,15,20,21 and age (>59 years old). 12 Histological subtype 13 and surgical margins or type of resection 3,12,20 do not appear to affect survival probability, supporting the tendency towards reduced excision margins (see below). Limited and somehow contrasting are the results of the sex prognostic value: Jahn et al 12 did not find it to be significant, while Ravin et al 13 confirmed this finding until approximately 7.5 years after diagnosis, but they pointed out higher long-term survival rates in women.…”

“…6,13,15 However, some contrasting data have been published: Augenstein et al 15 even claim ulceration as the strongest predictor of overall survival, while Jahn et al 12 showed that ulceration does not statistically influence the disease-specific survival. According to the literature, other significant prognostic factors for survival or recurrence rate are as follows: Clark level, 6,12 SLN positivity, clinically positive nodes, 6,13,15,20,21 and age (>59 years old).…”

“…Data on recurrence-free survival are limited. Jahn et al 12 reported a recurrence-free survival of 83% at 3-year follow up, and 79% at 5-year follow up (161 stage IeII patients). Lack and heterogeneity of data did not allow a KaplaneMeier analysis to be performed for recurrence-free survival.…”

“…Jahn et al 12 suggested a higher survival rate for patients in stage I and II, with a cumulative 5-year survival rate of 96%. The data suggest a poorer prognosis for patients presenting with node metastasis compared to melanomas of other regions, but the small number of patients does not allow for conclusions or for statistical considerations.…”

“…An excision margin of 0.5 cm, however, has been used not only for melanoma in situ 3,8 e as for other anatomical region e but also for melanomas with higher Breslow thickness: Bono et al 3 used a 0.5-cm margin for four non-in situ melanomas up to 5.92 mm in thickness, while Jahn et al 12 recommend a 0.5-cm margin for all LMMs, irrespective of the tumor thickness. They also report excision margins between 0.6 and 1 cm in other 37 patients with melanoma (data on the Breslow thickness not shown).…”