Fixed-tissue micrographic surgery for melanoma of the ear.

Auricular melanoma poses two primary problems: eradicating the primary neoplasm and managing potential satellites; both must be solved without spilling the highly transplantable cells. A secondary problem is the need to spare the cartilaginous framework that gives shape to the ear. With fixed-tissue micrographic surgery, all incisions are made through fixed (killed) tissue as successive layers of tissue are conservatively removed for microscopic scanning of their undersurfaces by the systematic use of frozen sections. Because no incisions are made through live tissue, no melanoma cells are spilled during the excision of the neoplasm and its "silent" outgrowths. Satellites too small to be seen are not moved or disturbed and can be removed as they appear. The reliability of the method is indicated by a five-year cure rate of 75% in a series of 17 patients.