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December 1988

Microscopic Surgery for Melanoma of the Ear

Arch Otolaryngol Head Neck Surg. 1988;114(12):1478. doi:10.1001/archotol.1988.01860240128041

To the Editor.—The article by Mohs1 is certainly interesting and highlights one single important issue; local recurrence and primary melanoma of the external ear is clinically a minor problem. Unfortunately, Mohs has failed to recognize that this issue has been addressed in the past. In 1980, we published our experience of 102 patients seen and treated at the University of Texas M. D. Anderson Cancer Center, Houston,2 and pointed to the fact that the single most important prognostic factor for survival was the presence or absence of nodal metastases. Of the 42 patients in the series who had nodal metastases, the five-year survival was 12%. Of the 60 patients without nodal metastases, the five-year survival was 75%. The most significant factor for predicting nodal metastases was the thickness of the primary malignancy rather than the level of invasion. Mohs fails to mention thickness in his article; he

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