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A Systematic Review of Surgical Management of Melanoma of the External Ear

BACKGROUND: Historically, external ear melanomas have been treated aggressively, due to early perceptions suggesting they had poor prognosis and aggressive biological behavior. More recent evidence has not supported these notions. METHODS: We completed a complete review of the literature involving m...

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Autores principales: Sawyer, Justin D., Wilson, Morgan L., Neumeister, Michael W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977960/
https://www.ncbi.nlm.nih.gov/pubmed/29876188
http://dx.doi.org/10.1097/GOX.0000000000001755
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author Sawyer, Justin D.
Wilson, Morgan L.
Neumeister, Michael W.
author_facet Sawyer, Justin D.
Wilson, Morgan L.
Neumeister, Michael W.
author_sort Sawyer, Justin D.
collection PubMed
description BACKGROUND: Historically, external ear melanomas have been treated aggressively, due to early perceptions suggesting they had poor prognosis and aggressive biological behavior. More recent evidence has not supported these notions. METHODS: We completed a complete review of the literature involving malignant melanoma of the external ear. We then completed a quantitative analysis on seventy-three cases from 8 reports that contained case-level data, assessing factors that influence recurrence, and assessing characteristics of the melanomas based on histological subtype. Baseline and outcomes data for all 20 studies were then compiled but not statistically evaluated. RESULTS: In our subanalysis, patients who had recurrence were significantly more likely to have had wedge resection versus wide-local excision, and those with no recurrence were more likely to have undergone wide local excision. Nodular tumors had significantly greater thickness. Overall, conservative excisions provided excellent outcomes. CONCLUSIONS: Conservative treatment for external ear melanoma produces satisfactory outcomes. There is no evidence to support the use of radical amputation and little evidence to support the removal of cartilage or perichondrium. Sentinel lymph node biopsy is warranted only with positive nodes. There is no role for elective neck dissection. The roles for chemo/radiation therapy are unclear and guidelines for other cutaneous melanomas should be followed.
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spelling pubmed-59779602018-06-06 A Systematic Review of Surgical Management of Melanoma of the External Ear Sawyer, Justin D. Wilson, Morgan L. Neumeister, Michael W. Plast Reconstr Surg Glob Open Original Article BACKGROUND: Historically, external ear melanomas have been treated aggressively, due to early perceptions suggesting they had poor prognosis and aggressive biological behavior. More recent evidence has not supported these notions. METHODS: We completed a complete review of the literature involving malignant melanoma of the external ear. We then completed a quantitative analysis on seventy-three cases from 8 reports that contained case-level data, assessing factors that influence recurrence, and assessing characteristics of the melanomas based on histological subtype. Baseline and outcomes data for all 20 studies were then compiled but not statistically evaluated. RESULTS: In our subanalysis, patients who had recurrence were significantly more likely to have had wedge resection versus wide-local excision, and those with no recurrence were more likely to have undergone wide local excision. Nodular tumors had significantly greater thickness. Overall, conservative excisions provided excellent outcomes. CONCLUSIONS: Conservative treatment for external ear melanoma produces satisfactory outcomes. There is no evidence to support the use of radical amputation and little evidence to support the removal of cartilage or perichondrium. Sentinel lymph node biopsy is warranted only with positive nodes. There is no role for elective neck dissection. The roles for chemo/radiation therapy are unclear and guidelines for other cutaneous melanomas should be followed. Wolters Kluwer Health 2018-04-13 /pmc/articles/PMC5977960/ /pubmed/29876188 http://dx.doi.org/10.1097/GOX.0000000000001755 Text en Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Article
Sawyer, Justin D.
Wilson, Morgan L.
Neumeister, Michael W.
A Systematic Review of Surgical Management of Melanoma of the External Ear
title A Systematic Review of Surgical Management of Melanoma of the External Ear
title_full A Systematic Review of Surgical Management of Melanoma of the External Ear
title_fullStr A Systematic Review of Surgical Management of Melanoma of the External Ear
title_full_unstemmed A Systematic Review of Surgical Management of Melanoma of the External Ear
title_short A Systematic Review of Surgical Management of Melanoma of the External Ear
title_sort systematic review of surgical management of melanoma of the external ear
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977960/
https://www.ncbi.nlm.nih.gov/pubmed/29876188
http://dx.doi.org/10.1097/GOX.0000000000001755
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