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Background: The optimal surgical technique for managing external ear melanoma and its corresponding prognosis remain areas lacking comprehensive data. In this retrospective study were patients treated with a cartilage-sparing excision of melanoma of the external ear. The primary objectives are to evaluate local control rates, overall survival, and disease-specific survival. Methods: After conducting a structured review encompassing surgical methodologies and survival rates, a clinical retrospective analysis was undertaken involving patients treated from 2011 to 2022. The treatment approach across all cases involved cartilage-sparing resection followed by wound closure utilizing primary closure or split/full-thickness skin grafting for reconstruction. Statistical analysis was conducted employing the Kaplan–Meier survival analysis. Results: Superficial spreading melanoma represents the predominant histological subtype observed. In all cases, patients underwent cartilagesparing resection of the tumor. Among them, 9 patients underwent simultaneous sentinel lymph node biopsy during resection, all of which yielded negative results. Subsequent to treatment, 1 patient experienced local recurrence after 9 months, while another presented with locoregional recurrence in a lymph node after 15 months. No instances of distant metastasis were recorded within the patient cohort. The local control rate was 92.86%, the overall survival 100% and the disease-specific survival 100%. The average follow-up was 41 months. Conclusion: The outcomes regarding local control rate, overall survival, and disease-specific survival underscore the efficacy of cartilage-sparing resection as a viable treatment modality, particularly for early-stage melanoma cases. These results not only highlight the significance of achieving tumor-free margins but also emphasize the importance of attaining aesthetically satisfactory outcomes. Consequently, cartilage-sparing resection emerges as an acceptable therapeutic approach for managing melanoma of the external ear, offering promising prospects for patients in terms of both medical and cosmetic considerations [ABSTRACT FROM AUTHOR]