Natural history of pain associated with melanoma surgery. (November 2018)

• Record Type: Journal Article
• Authors: Slagelse, Charlotte; Munch, Troels; Glazer, Clara; Greene, Kaitlin; Finnerup, Nanna Brix; Kashani-Sabet, Mohammed; Leong, Stanley P.; Petersen, Karin Lottrup; Rowbotham, Michael C.
• Is Part Of: Pain reports. Volume 3:Number 6(2018)
• Publication Date: 2018-11
• Subjects: Melanoma -- Sentinel node biopsy -- Complete lymph node dissection -- Neuropathic pain -- Postoperative pain -- Cancer pain -- Sensory symptoms
• DOI: 10.1097/PR9.0000000000000689
• Languages: English
• ISSNs: 2471-2531

Abstract

Abstract: Introduction: After excision of a primary malignant melanoma (MM), treatment of stage IB or higher MM consists of sentinel lymph node biopsy (SLNB). If malignant cells are identified, a complete lymph node dissection (CLND) can be performed. Objective: To determine the natural history of pain and sensory changes after MM surgery. Methods: We prospectively followed 39 patients (29 SLNB-only, 2 CLND-only, and 8 CLND preceded by SLNB) from before inguinal or axillary surgery through 6 months after surgery on measures of pain intensity, sensory symptoms, allodynia, and questionnaires of anxiety, depression, and catastrophizing. Results: No patient had pain preoperatively. Ten days after surgery, 35% had surgical site pain after SLNB-only compared with 90% after CLND ( P < 0.003); clinically meaningful pain (Visual Analogue Scale ≥ 30 mm/100 mm) was reported by 3% of patients after SLNB-only compared with 40% after CLND ( P < 0.001). At 6 months, all SLNB-only patients were pain-free. By contrast, 4 of 7 in the SLNB + CLND group still had pain ( P < 0.002). At 6 months, symptoms of altered sensation or numbness were reported by 32% and 42% of SLNB-only patients, and by 67% and 67% of patients undergoing CLND surgery (both P > 0.05). Conclusion: Acute pain is more common after CLND surgery. Undergoing SLNB followed by more invasive CLND surgery may increase the likelihood of pain at 6 months. Persistent sensory symptoms typical of those associated with nerve injury are more common after CLND. Surgery for MM is a good model for studying the natural history of postsurgical pain and sensory changes.