The Perichondrium in Auricular Melanomas: Implications for Surgical Management. Issue 3 (7th December 2012)

• Record Type: Journal Article
• Authors: Craig, E. Stirling; Nagarajan, Priyadharsini; Lee, Esther S.; Lazova, Rossitza; Terner, Jordan; Narayan, Deepak
• Is Part Of: Otolaryngology--head and neck surgery. Volume 148:Issue 3(2013)
• Page Start: 431
• Page End: 435
• Publication Date: 2012-12-07
• Subjects: ear melanoma -- auricular melanoma -- perichondrium -- surgical management -- skin resection; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599812470426
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objective: Auricular melanomas are now considered less aggressive than originally thought, but those located on the conchal bowl and posterior ear can create particular challenges for reconstruction. Given the paucity of cases, no standardized recommendations exist for tumor resection. In this study, we provide a pathologic basis in support of conservative tumor resection along the perichondrial plane. Study Design: Case series with review of pathology and medical records. Setting: Academic tertiary referral center. Subjects and Methods: We retrospectively reviewed all ear melanomas from the archives of Yale Dermatopathology and Surgical Pathology laboratories between 1987 and 2009. Cases of melanoma in situ or malignant melanoma of the earlobe were excluded. Results: Fifty‐one cases were included in the study. Patients' age ranged from 26 to 94 years, with a mean (SD) of 58.9 (17.5) years. The male to female ratio was of 5.4:1. Melanomas were distributed similarly between right and left ears, at 52% and 48%, respectively. The most common location was the helix (74.5%). The Breslow depth ranged from 0.19 to 11 mm, with a mean (SD) of 1.64 (1.6) mm. The lesion‐perichondrium distance ranged from 0 to 8.12 mm, with a mean (SD) of 1.11 (1.1) mm. Notably, the perichondrium was not invaded in any of the cases. Conclusion: Based on the histopathologic characteristics of our cases, the perichondrium can be considered an effective barrier and therefore a biological plane for wide local resection in some cases of auricular melanomas, allowing surgeons to achieve negative margins without necessarily sacrificing underlying cartilage.