title: Persistent postoperative pain and sensory changes following lymph node excision in melanoma patients: a topical review.
abstract: Studies on complications related to chronic nerve injury following sentinel lymph node biopsy (SLNB) and complete lymph node dissection (CLND) for melanoma are sparse. This review summarizes the existing literature on pain and neuropathic complications in melanoma patients undergoing SLNB with or without CLND. The Cochrane Central Register of Controlled Trials and the Embase and PubMed databases were searched. Full-text English language articles published before June 2013 were included. Prospective and retrospective studies assessing persistent (>1 month) sensory nerve injury, postoperative pain, neuropathic pain, and sensory disturbances following SLNB with or without CLND in melanoma patients were eligible. Nine studies (six prospective and three retrospective) including data for 3632 patients met our inclusion criteria. Outcome parameters were too heterogeneous to conduct a quantitative analysis, and few studies systematically evaluated pain and sensory abnormalities. Persistent postoperative pain was reported in 1-14% of patients following SLNB and in 6-34% following CLND and sensory abnormalities in 0.1-32 and 2-82%, respectively. In the one study that assessed the type of pain, neuropathic pain was suggested to explain persistent pain in 31-66% of patients with SLNB and 82-89% of patients with CLND. Sensory-nerve-related complications in melanoma patients seem to be less pronounced following SLNB compared with CLND. Prospective observational studies are necessary to identify predictors of persistent pain, to evaluate the prevalence and impact of pain and sensory abnormalities, and to develop strategies for prevention of long-term complications.
authors.affiliation: aCalifornia Pacific Medical Center Research Institute bDepartment of Medicine, Division of Rheumatology, University of California at San Francisco, San Francisco, California, USA cDepartment of Anaesthesia, Rigshospitalet and Copenhagen University dMultidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen eDanish Pain Research Center, Aarhus University, Aarhus fDepartment of Plastic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Slagelse
authors.forename: Karin L
authors.initials: KL
authors.lastname: Petersen
authors.forename: Jørgen B
authors.initials: JB
authors.lastname: Dahl
authors.forename: Kenneth
authors.initials: K
authors.lastname: Finnerup
authors.forename: Kaitlin
authors.initials: K
authors.lastname: Greene
authors.forename: Stanley P
authors.initials: SP
authors.lastname: Leong
authors.forename: Jon
authors.initials: J
authors.lastname: Levine
authors.forename: Michael
authors.initials: M
authors.lastname: Rowbotham
authors.forename: Mads U
authors.initials: MU
authors.lastname: Werner
authors.forename: Nanna B
authors.initials: NB
authors.lastname: Finnerup
mesh_terms: D006801:Humans; D008197:Lymph Node Excision; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D009437:Neuralgia / Q000209:etiology* / Q000473:pathology; D010149:Postoperative Pain / Q000209:etiology* / Q000473:pathology; D011446:Prospective Studies; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires