External Ear Melanoma Treated with Auricular Reconstruction Using Four Different Tissues in a 16-Year-Old Patient

Abstract

The auricular region is a common site of cutaneous malignancies, most of which are nonmelanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma, in older patients. They are often treated with limited surgery that can be performed under local anesthesia. We report the case of a young patient with external ear melanoma who underwent reconstruction for defects of more than one-half of the helix and concha using four types of tissues: a rib cartilage graft, temporoparietal fascia flap, full-thickness skin graft, and retroauricular flap. Extending the retroauricular flap posteriorly to the entire hairless area allowed us to cover the anterior surface of the rib cartilage framework, which helped effectively achieve aesthetics. In auricle reconstruction, it is crucial to determine how well the anterior surface of the auricle is created.

Fig. 1.

Photographs after tumor resection. More than half of the defects in the helix extend to the concha. Sentinel lymph node biopsy was performed from the inferior margin of the retroauricular flap (white arrow), and another incision was made in the neck (yellow arrow).

Fig. 2.

Schema of surgical procedure. A, The framework was reconstructed with right sixth and seventh rib cartilage graft for defects beyond the central half of the helix and antihelix. The smaller posterior portion was the sixth costal cartilage, and the larger anterior portion was the seventh. Their attachments to each other were left connected. B, The retroauricular flap extended to the entire posterior hairless area. The flap was moved anteriorly through the conchal cartilage defect. C, The temporoparietal fascial flap was elevated through an arc-shaped temporal incision and covered the rib cartilage of the helix, which was not covered by the retroauricular flap, through a subcutaneous tunnel on the cranial side of the auricle. D, A full-thickness skin graft was taken from the rib cartilage donor site, and the postauricular region on the unaffected side was placed over the temporoparietal fascia flap and donor site of the retroauricular flap.

Fig. 3.

Photograph taken at the end of reconstructive procedure. The retroauricular flap covered the concha and the rib cartilage framework of the antihelix. Full-thickness skin grafts on the temporoparietal fascia flap covered the framework of the helix.

Fig. 4.

Postoperative view seven months after reconstruction. The reconstructed ear was slightly pigmented; however, the morphology was good.