Saturday, May 18, 2019

Melanoma




It is always important to examine the ears carefully when carrying out a skin check.  This small pigmented lesion was a regressed invasive melanoma 0.2 mm thick. The patient was entirely unaware of it’s existence. Men are particularly susceptible to solar damage on the ear because of their short hair. It is exacerbated by only wearing a baseball cap rather than a brimmed hat. It is a good idea to run your finger over the surface of the pinna. This will pick up small solar keratoses better than just visually examining the ear.  Always examine the junction of the ear with the skull posteriorly. Basal cell carcinoma can arise here and go deep into this embryonic fusion area. Another area to look at carefully is in the conchae around the external auditory meatus. Again men are more likely than women to develop BCCs in this area and if it is an infiltrating BCC and it starts to grow into the external meatus and down the auditory canal, then the patient is in real trouble.  Note also that squamous cell carcinomas of the ear are more likely to metastasise than many other areas of the body and so should be excised widely and early.