Natural history of pain associated with melanoma surgery

• Main Authors: Charlotte Slagelse, Troels Munch, Clara Glazer, Kaitlin Greene, Nanna Brix Finnerup, Mohammed Kashani-Sabet, Stanley P. Leong, Karin Lottrup Petersen, Michael C. Rowbotham
• Format: Article
• Language: English
• Published: Wolters Kluwer 2018-12-01
• Series: PAIN Reports
• Online Access: http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000689

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.