Late arm and shoulder problems after axillary therapeutic lymph node dissection in patients with melanoma

Abstract

Introduction

Lymphedema is exempted, only a few studies have dealt with the late adverse effects in melanoma patients who have undergone axillary therapeutic lymph node dissection (ATLND) for the clinical nodal disease. We evaluated the data on late arm/shoulder problems (ASPs) reported by the patients and daily life impairment after ATLND and identified the risk factors.

Material and methods

Between 2008 and 2014, 82 patients underwent full en bloc Level I-III ATLND. After a median of 56 months (range 34–104), 76 patients (compliance: 93%) rated their ASPs and daily life dysfunction in a questionnaire, leading to the calculation of individual a Symptom/Problem Summary Score and a Function Summary Score. Multivariate analyses identified risk factors.

Results

Two groups of patients were identified. Group 1: no or mild ASPs, n = 56 (74%). Group 2: at least one moderate, severe and very severe ASP, n = 20 (26%). Overall, lymphedema, numbness and restricted arm movements represented the most frequent ASPs. Based on the distribution of the summary scores, about 60% of the patients reported no or only mild symptoms/problems and no or mild dysfunction. More than mild impairment of daily life was reported by five patients. On multivariate analyses, increasing tumor size and decreasing age were identified as risk factors.

Conclusion

Our sample shows that ATLND in melanoma patients with the clinically detectable disease can be performed without a major risk of late ASPs and impaired daily life. Increasing tumor size and decreasing age at the surgery are risk factors for developing ASP-related dysfunction.

Keywords:

• Melanoma
• axillary therapeutic lymph node dissection
• late arm/shoulder problems
• plastic surgery

Acknowledgments

The authors would like to thank Anders Gullestad and Mariusz Goscinski for their constructive criticism of the manuscript.

Disclosure statement

The authors declare no competing interests as defined by the journal or other interests that might be perceived to influence the results and discussion in this paper.