AI Article Synopsis
- After surgery for malignant melanoma, sentinel lymph node biopsy (SLNB) usually leads to less pain compared to complete lymph node dissection (CLND), with notable differences in pain intensity observed post-operation.
- In a study of 39 patients, a significant percentage experienced pain and sensory changes, with 90% reporting pain after CLND compared to only 35% after SLNB ten days post-surgery, and some still experiencing pain six months later.
- The findings suggest that CLND results in higher rates of acute pain and persistent sensory symptoms, indicating that surgical methods for melanoma offer valuable insights into the nature of postsurgical pain and recovery.
Article 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 ( < 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 ( < 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 ( < 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 > 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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344134 | PMC |
| http://dx.doi.org/10.1097/PR9.0000000000000689 | DOI Listing |
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