The scapha (elongated hollow) is reduced, and a segment of the helical rim is excised, and the incision is closed primarily to avoid redundancy. Microtia — A congenital defect characterized by either the severe underdevelopment or the absence of the pinna (outer ear). At one end of the spectrum is a pinna slightly smaller than normal, but of normal appearance, and at the other end of the spectrum is anotia, the absence of the pinna. The 'Nagata classification' correlates the ear deformity with the surgical approach thus: Lobule type — The patient has an ear remnant and malpositioned lobule, but no concha, acoustic meatus, or tragus. Concha type — The patients presents an ear remnant, malpositioned earlobe, concha (with or without acoustic meatus), tragus, and antitragus with an incisura intertragica. Small concha type — The patient presents an ear remnant, malpositioned lobule, and a small indentation instead of a concha. Anotia — The patient presents either no ear remnant, or a minute, ear remnant. (v) Atypical microtia — The patient presents deformities of the ear that are not comprehended in the four preceding Nagata classifications. Question mark ear — A rare congenital defect characterized by a protuberant pinna (external ear) with a cleft (indentation) between the earlobe and the outer cartilage rim, between the fifth and sixth hillocks. This deformity also is known as 'Cosman ear', after Dr. Bard Cosman (1931–1983), the American plastic surgeon who identified it. The degree of anatomical deficiency is variable, and usually can be corrected with a cartilage graft and a V-Y advancement-flap of retroauricular skin, harvested from the back of the ear, because there often is excess skin in the upper-third of the ear being corrected. To reconstruct a 'Question mark' ear featuring a severely deformed pinna, the otoplastic procedure for correcting microtia is applied. Scroll ear — A congenital defect characterized by the outer edge of the ear curling forward, inwards (like a curled scroll), and towards the head. Skin cancer and malignant melanoma — Cutaneous malignancies of the helical rim can be excised and closed with the Antia–Buch helical advancement technique. Cancerous lesions in the concha or over the antihelix can usually be excised and skin grafted. If the cartilage is involved, it can be excised and the graft placed directly on the posterior skin. Malignant melanomas should be excised with the same margins as melanomas of the equivalent depth in other