parts of the body. Melanoma in situ does not require a full-thickness excision, and is excised with a margin, to preserve the perichondrium, and then covered with a skin graft. Invasive melanomas of the helical rim require wedge resection to achieve adequate margins; these defects might be large and require secondary reconstruction. Stahl's ear deformity — A pointed-ear defect characterized by an abnormal folding of the skin and cartilage of the pinna, which produce an "elfin ear" characterized by an ear-rim with a pointed upper-edge, rather than a rounded upper-edge. Wildermuth's ear — A congenital defect characterized by a backwards-oriented helix (the pinna's curved, cartilage border), which deforms the ear by protruding the ante-helix (inner ridge of the pinna). The eponym derives from Hermann A. Wildermuth (1852–1907), the German neurologist who identified the defect. Surgical procedures Otoplastic surgery can be performed upon a patient under anesthesia — local anesthesia, local anesthesia with sedation, or general anesthesia (usual for children). In order to correct a lop ear with a small helix (the cartilage-supported outer rim of the pinna), an incision to one side of a flat cartilage piece leaves unopposed elastic forces on the opposite side, which permits the evolution of the ear contour; thus, a small incision on one side of the lop-ear cartilage, along the new anti-helical fold, can be a technical element of the corrective ear surgery. Yet, when done without an incision, the procedure is deemed an 'incisionless otoplasty', wherein the surgeon places a needle through the skin, to model the cartilage and to emplace the retention sutures that will affix the antihelix and conchal bowl areas. Surgical otoplasty techniques Depending upon the auricular (pinna) defect, deformity, or reconstruction required, the surgeon applies these three otoplastic techniques, either individually or in combination to achieve an outcome that produces an ear of natural proportions, contour, and appearance: Antihelical fold manipulation Suturing of the cartilage: the surgeon emplaces mattress sutures on the back of the ears, which are tied with sufficient tension to increase the definition of the antihelical fold, thereby setting back the helical rim. The cartilage is not treated. This is the technique of Mustardé and Merck, though each method differs: whereas the Mustardé method is an open invasive method, by which the cartilage on the back of the ears is extensively exposed and an area of skin is excised, the Merck method is a closed minimally