10.5826/dpc.1301a33
text/xml
2160-9381
2515
en
Virginia Mariana González
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
ear
Dermoscopic Features of External Ear Melanoma: A Case Series
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-01-31
2022-04-05
2023-01-31
2023-02-27
e2023033
Dermatol Pract Concept
Virginia Mariana González
2023/01/31
10.5826/dpc.1301a33
e2023033
Dermatology Department, Hospital Alemán, Buenos Aires, Argentina
2160-9381
ear
en
e2023033
Kittler H, Marghoob AA, Argenziano G, et al. Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. J Am Acad Dermatol. 2016;74(6):1093–1106. DOI: 10.1016/j.jaad.2015.12.038. PMID: 26896294. PMCID: PMC5551974.
Dermoscopic Features of External Ear Melanoma: A Case Series
https://dpcj.org/index.php/dpc/article/download/2515/1914
                        Dermoscopic Features of External
                          Ear Melanoma: A Case Series
              Rosario Peralta1, Horacio Cabo2, Emilia Cohen Sabban1, Gabriel Salerni3,
                                    Virginia Mariana González4


1 Dermatology Department, Instituto de Investigaciones Médicas “A. Lanari”, University of Buenos Aires, Buenos Aires, Argentina
2 Dermatology Deparment, University of Buenos Aires, Buenos Aires, Argentina
3 Dermatology Department, Hospital Provincial del Centenario de Rosario, Rosario, Argentina
4 Dermatology Department, Hospital Alemán, Buenos Aires, Argentina



Key words: Melanoma, dermoscopy, ear
Citation: Peralta R, Cabo H, Cohen Sabban E, Salerni G, González VM. Dermoscopic Features of External Ear Melanoma: A Case Series.
Dermatol Pract Concept. 2023;13(1):e2023033. DOI: https://doi.org/10.5826/dpc.1301a33
Accepted: June 1, 2022; Published: January 2023
Copyright: ©2023 Peralta et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Peralta Rosario, MD, 3150 Combatientes de Malvinas, CP 1427, Ciudad Autónoma de Buenos Aires, Argentina.
Tel: (+54) 011-5287-3788, Email: rosarioperalta@yahoo.com




Introduction                                                             Case Presentation
External ear melanoma (EEM) is a rare condition, corre-                  Eight patients (7 men and 1 woman) with biopsy-proven
sponding to 1%-4% of all cutaneous melanomas. It affects                 diagnosis of melanoma were analyzed. The median age was
mainly individuals in the sixth decade of life, being predom-            68 years (range, 54–82 years). Two were located on the
inantly observed in white men, in the auricular helix. The               right helix, 3 on the left helix, 1 on the right lobe, 1 on
most common subtype that have been reported is the super-                the left antihelix and 1 on the left antitragus. All of them
ficial spreading melanoma (40.1%), followed by the lentigo               presented as a single lesion and only two patients noticed
maligna (33.7%) [1]. EEM usually exhibits the classical                  its appearance before consultation. Clinically, they were
features of facial or extra-facial melanoma, both clinically             pigmented brown macules, with the exception of one that
and dermoscopically [2]. The majority of these melanomas                 presented as a multicolored, slightly raised lesion. Most of
are diagnosed in early stages, when the Breslow thickness                them showed asymmetrical shape. Upon dermoscopy, in 6
is less than 2 mm, in 75% of patients [1]. We report eight               out of 8 lesions, we found features of lentigo maligna, such
clinical cases of EEM and their dermoscopic findings, diag-              as asymmetric pigmented follicular openings, rhomboidal
nosed at an early stage, emphasizing the importance of the               structures and dark brown homogeneous areas without
routine clinical examination of the ears in the dermatological           obliterated hair follicles (Figure1, A-F), 1 lesion presented
consultation.                                                            dark brown homogeneous areas with obliterated hair fol-
                                                                         licles (Figure 1G) and 1 exhibited criteria for superficial



Research Letter | Dermatol Pract Concept. 2023;13(1):e2023033                                                                        1
Figure 1. Clinical and dermoscopic images of external ear melanomas. Dermoscopic examination developed. (A,B) Asymmetric pig-
mented follicular openings, and concentric circles. (B) Zig-zag pattern (black arrows) and some rhomboidal structures (black asterisk).
(C) Annular-granular pattern. (D,E) Rhomboidal structures. (F) Dark brown homogeneous areas without obliterated hair follicles. (G) Dark
brown homogeneous areas with obliterated hair follicles. (H) Multicomponent pattern with multiple colors, atypical pigment network, neg-
ative network, irregular blotches and dotted and linear irregular vessels distributed peripherally (white arrow).



spreading melanoma with a multicomponent pattern with
                                                                      Conclusions
atypical pigment network, negative network, irregular
blotches and atypical vessels (Figure 1H). Clinical and de-           In the dermoscopic findings of this EEM case series we
mographic data, dermoscopic findings and histopathologic              achieved similar results to those in previous reports, show-
result are detailed in Table 1.                                       ing classical dermoscopic features of facial and extra-facial
                                                                      melanomas.



2                                                                         Research Letter | Dermatol Pract Concept. 2023;13(1):e2023033
                        Table 1. Clinical and demographic data, dermoscopic findings and
                          histopathological subtype of external ear melanoma patients.
                Age              Anatomical        Single lesion                                            Histopathological
 Patient #    (Years)     Sex       site             (Yes/No)            Dermoscopic Findings                    subtype
 1               57      M       Right helix     Yes                Asymmetric pigmented follicular       Lentigo maligna
                                                                    openings, concentric circles
 2               70      F       Right lobe      Yes                Asymmetric pigmented follicular       Lentigo maligna
                                                                    openings, zig-zag pattern,
                                                                    rhomboidal structures
 3               55      M       Left            Yes                Annular-granular pattern,             Lentigo maligna
                                 antihelix                          rhomboidal structures
 4               54      M       Left            Yes                Annular-granular pattern,             Lentigo maligna
                                 antitragus                         rhomboidal structures, dark
                                                                    brown homogeneous areas
                                                                    without obliterated hair follicles
 5               74      M       Right helix     Yes                Gray color, annular-granular          Lentigo maligna
                                                                    pattern, rhomboidal structures
 6               73      M       Left helix      Yes                Asymmetric pigmented follicular       Lentigo maligna
                                                                    openings, rhomboidal structures,
                                                                    dark brown homogeneous areas
                                                                    without obliterated hair follicles
 7               82      M       Left helix      Yes                Annular-granular pattern,             Lentigo maligna
                                                                    rhomboidal structures, dark           melanoma, Breslow
                                                                    brown homogeneous areas with          0,6 mm
                                                                    obliterated hair follicles
 8               65      M       Right helix     Yes                Multicomponent pattern with           Superficial spreading
                                 and auricle                        atypical pigment network,             melanoma, Breslow
                                                                    negative network, irregular           1,2 mm
                                                                    blotches and atypical vessels


     Face-specific dermoscopic criteria of melanoma are            impacts on survival and dermoscopy has been shown to aid
asymmetric pigmented follicular openings, concentric circles,      in the correct diagnosis.
annular-granular pattern, rhomboidal structures, and homo-
geneous areas. Extra facial melanoma features in general
                                                                   References
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                                                                       tion of terminology in dermoscopy/dermatoscopy: Results of
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                                                                       the third consensus conference of the International Society of
inforced, recommending the use of the dermatoscope when                Dermoscopy. J Am Acad Dermatol. 2016;74(6):1093–1106.
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Research Letter | Dermatol Pract Concept. 2023;13(1):e2023033                                                                      3
