Original Articles: Clinical ResearchRecurrence risk of early-stage melanoma of the external ear an investigation of surgical approach and sentinel lymph node statusTruong, Amandaa,,b,,*; Hyngstrom, John R.a,,c,,g,,*; Andtbacka, Robert H.I.a,,c; Noyes, R. Dirka,,c,,g; Wright, Melissag; Snyder, Johng; Winters, Alyssag; Sause, William T.g; Grossmann, Kenneth F.a,,d; Khong, Hung T.h; Bowen, Glen M.a,,e; Hitchcock, Ying J.a,,f; Grossman, Douglasa,,e; Bowles, Tawnya L.a,,c,,gAuthor Information aHuntsman Cancer Institute bUniversity of Utah School of Medicine cDepartment of Surgery dDepartment of Internal Medicine eDepartment of Dermatology fDepartment of Radiation Oncology, University of Utah gIntermountain Healthcare, Salt Lake City, Utah hDepartment of Breast Oncology, Moffitt Cancer Center, Tampa, Florida, USA * Amanda Truong and John R. Hyngstrom contributed equally to the writing of this article. Received 19 June 2018 Accepted 8 October 2018 Correspondence to Tawnya L. Bowles, MD, Intermountain Medical Center, 5169S, Cottonwood Street, Eccles Building Suite #440, Murray, UT 84107, USATel: +1 801 507 3915; fax: +1 801 507 3916; e-mail: email@example.com Melanoma Research: April 2020 - Volume 30 - Issue 2 - p 173-178 doi: 10.1097/CMR.0000000000000534 Buy Metrics Abstract Surgical management of external ear melanoma presents unique technical challenges based on the unique anatomy and reconstruction concerns. Surgical technique, including preservation of cartilage, is variable and impact on recurrence is unclear. Our goal was to investigate surgical approach, including extent of surgical resection and sentinel lymph node biopsy (SLNB), and the impact on recurrence. In this retrospective review of primary clinical stage 1/2 external ear melanoma, demographics, tumor characteristics, surgical resection technique (including cartilage-sparing vs. cartilage removal), and SLNB results were evaluated for recurrence risk. One hundred and fifty-six patients total had an average follow-up of 5.6 years. Twenty-nine (18.6%) patients underwent cartilage-sparing surgery and 99 (63.5%) patients underwent SLNB, 14.1% of whom had micrometastatic disease. Ten (6.4%) patients recurred loco-regionally. Recurrence was associated with Breslow depth, initial stage at diagnosis, and SLNB status. Cartilage-sparing surgery was not associated with increased recurrence. Sentinel lymph node identification rate was 100% based on clinical detection with use of lymphoscintigraphy. In addition to confirming established risk factors for melanoma recurrence, we confirm the feasibility of SLNB in stratifying recurrence risk. Although we did not see an increased recurrence risk with surgical technique and cartilage-sparing approaches, these findings are limited by small sample size. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.