PAIN Reports (Dec 2018)

Natural history of pain associated with melanoma surgery

  • Charlotte Slagelse,
  • Troels Munch,
  • Clara Glazer,
  • Kaitlin Greene,
  • Nanna Brix Finnerup,
  • Mohammed Kashani-Sabet,
  • Stanley P. Leong,
  • Karin Lottrup Petersen,
  • Michael C. Rowbotham

DOI
https://doi.org/10.1097/PR9.0000000000000689
Journal volume & issue
Vol. 3, no. 6
p. e689

Abstract

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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 0.05). 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.