Dermatosurgical approach to the ear

The external ear presents unique challenges in dermatosurgery due to its complex three-dimensional anatomy, aesthetic significance, and status as a high-risk "H-zone" for sun-induced malignancies. We present a guide for managing auricular lesions, encompassing essential anatomy, pathology, and reconstructive strategies. We discuss a wide range of conditions, including malignant (basal cell carcinoma, squamous cell carcinoma, and melanoma), premalignant (actinic keratosis and Bowen disease), and benign (keloids and chondrodermatitis nodularis helicis chronicus) lesions. Surgical principles prioritize functional integrity, such as maintaining support for eyewear or hearing aids, and aesthetic balance. Dermatosurgeons should be familiar with appropriate techniques for tumor removal and reconstruction. In the surgical removal of skin lesions (excision), anatomic considerations and specific characteristics of the lesion are crucial for the healing process, functionality, and aesthetic outcome. Planning considers the type of lesion, its location, and skin tension. The surgical ladder ranges from primary closure and secondary intention to skin grafts and local flaps. Postoperative wound care is essential for the best possible outcome. In several cases, the complexity of the auricle warrants a multidisciplinary approach, integrating dermatology, otolaryngology, and plastic surgery, to achieve optimal functional and cosmetic outcomes.