|Year : 2017 | Volume
| Issue : 4 | Page : 270-272
Aural melanocytic nevi presented as polypoidal mass
Jeyasakthy Saniasiaya1, Mohd Khairi Md Daud1, Ramiza Ramza Ramli1, Hilma Hazmi2, Hasnan Jaafar2
1 Department of Otorhinolaryngology Head and Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
2 Department of Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
|Date of Web Publication||2-May-2018|
Prof. Mohd Khairi Md Daud
Department of Otorhinolaryngology Head and Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan
Source of Support: None, Conflict of Interest: None
Nevus is a benign melanocytic tumor which occurs anywhere in the skin and is considered to be the most common type of skin tumor. Albeit rare, its manifestation over the external auditory canal has been reported. Herein, we present a case of a previously healthy middle-aged female who presented with insidious onset of left-sided aural fullness and tinnitus. Otoscopic finding revealed a peculiar-looking blackish polypoidal mass occupying left ear canal. Histopathological examination of the excised polypoidal mass turned out to be intradermal melanocytic nevi. Melanocytic nevi in the ear canal may presents as polypoidal mass in a long-standing case. Any suspicious mass over the external auditory canal warrants excision along with histopathological examination of the excised mass as to exclude the possibility of malignancy.
Keywords: External auditory canal, nevus, polyps
|How to cite this article:|
Saniasiaya J, Daud MK, Ramli RR, Hazmi H, Jaafar H. Aural melanocytic nevi presented as polypoidal mass. Indian J Otol 2017;23:270-2
| Introduction|| |
Nevi are generally pigmented benign tumor arising as a result of the proliferation of melanocytes from dermo-epidermal junction. These proliferated melanocytes form nests and migrate to the dermis. Intradermal melanocytic nevi are also termed as nevomelanocytic nevi which is composed of nevus cells. Albeit common, its presentation in the external auditory canal is rare.
| Case Report|| |
A previously healthy 45-year-old female presented to our clinic preceded by a 4-month history of left-sided aural fullness and tinnitus which remained the same over the time. Apart from that, patient denies any preceding otorrhea, otalgia, or otorrhagia and there was no accompanying reduced hearing, giddiness, or facial asymmetry. There was also no history of recent trauma, fall, or upper respiratory tract infection. Other than that, there was no accompanying nasal or oral symptoms.
The patient lives with her husband and children with all the other members of her family well, none of whom with similar symptoms. The family members had no recent contact with any tuberculosis or sick contacts or any travel outside the town recently.
Upon examination, the patient was in tranquil state, not septic looking, and afebrile with no obvious facial asymmetry. Bilateral external ears were symmetrical with no deformity. Otoscopic examination over left ear canal revealed a multiple blackish polypoidal mass which was nonpulsatile and nontender upon probing with no obvious discharge obscuring the tympanic membrane [Figure 1]. It was also difficult to identify the attachment or origin of the tumor. The left ear canal, on the other hand, was normal with an intact tympanic membrane.
|Figure 1: Otoscopic finding showing blackish polypoidal mass in the external auditory canal|
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Oropharynx examination was insignificant, and neck nodes were not palpable. Nasoendoscopy revealed no signs of active infection or the presence of any suspicious mass. All other cranial nerves were intact and no evident for other neurological deficits. Systemic examination was normal. Tuning fork test was normal. Full blood count and electrolytes were also within normal range. In the light of patient's presentation and clinical examination, a provisional diagnosis of aural papilloma was made.
The patient was subsequently counseled for examination under anesthesia with polypectomy which she agreed upon. Intraoperatively, blackish polypoidal mass was seen occupying outer third of ear canal, broad-based stalk attached to the superior part of outer third of external ear canal. No keratin or debris seen beyond the mass, and the tympanic membrane is intact. Histopathological examination of the aural mass sent revealed an intradermal lesion with cells arranged in nests and sheets and presence of neurotization [Figure 2]a, [Figure 2]b, [Figure 2]c. In addition to that, melanin pigment can be seen in the subepithelial layer. Postoperatively, the patient was well, and she was discharged home the following day with no other accompanying complications. Upon follow-up, patient was well with no new complaints.
|Figure 2: (a): Section shows multiple fragments of polypoidal tissue covered by keratinized stratified squamous epithelium (H and E, ×40) (b) There are intradermal lesions composed of cells arranged in nests and sheets. Melanin pigment seen especially in the subepithelial layer. Neurotization seen (H and E, ×100). (c) The cells arranged in nests have round to oval nuclei with fine chromatin and inconspicuous nucleoli. The cytoplasm is syncytial and is moderate in amount. Melanin pigments seen in the subepithelial layer with no junctional activity seen. (H and E × 200)|
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| Discussion|| |
Melanocytic nevus is the most common benign skin tumor which can be found anywhere on the skin. Its presentation in the external auditory canal has been reported in <20 cases in the English-language literature till date.
The common clinical presentation includes aural pruritus, aural fullness, foreign body sensation, conductive hearing loss, otalgia, and excessive accumulation of wax. Having said that, in most cases, these entities were found incidentally. Our patient presented with aural fullness with tinnitus.
Nevus has always been described as papillomatous, dome-shaped, pedunculated, or flat topped and is pigmented, pink or flesh colored. In our patient, aural mass appeared papillomatous with blackish color causing suspicion toward melanoma.
Diagnosis of melanocytic nevi is based solely on histopathological examination as there is no pathognomonic clinical presentation. Histopathological characteristics of this entity include the presence of nevus cells which are melanocytes that are arranged at least partially in cluster or nests. It can be further classified into junctional, intradermal, and compound.
These melanocytic nevi can be clinically divided into five macrocytic types including flat, slightly elevated lesions, halo, verrucous, and dome-like lesion. Melanocytic nevi which occur among adults are intradermal type, whereas in children, they are oftentimes of junctional type. This description fits our patient as she has intradermal type of melanocytic nevi.
Radiological examination is of scarce value for diagnosing this entity as there are no pathognomonic imaging characteristics. No imaging was done for our patient as she underwent a diagnostic polypectomy.
Gold standard treatment in these cases remains surgery; notably, examination under anesthesia and polypectomy as melanocytic nevi can only be diagnosed after histopathological examination. As for our patient, she underwent a simple examination under anesthesia along with polypectomy as it was done both for diagnostic and therapeutic purpose.
Differential diagnosis for this entity includes viral warts, lentigo, seborrheic keratosis, dysplastic nevus, inflammatory polyp, squamous papilloma, and malignant lesions including malignant melanoma, basal cell carcinoma, and squamous cell carcinoma. However, unlike the usual melanoma which progresses over time, melanocytic nevi involute over time.
| Conclusion|| |
Melanocytic nevi in the ear canal may present as polypoidal mass in a long-standing case. Any suspicious mass over the external auditory canal warrants excision along with histopathological examination of the excised mass as to exclude the possibility of malignancy.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]