Axillary web syndrome: An underappreciated complication of sentinel node biopsy in melanoma

Darryl Schuitevoerder, Ian White, Jeanine Fortino, John Vetto

    Research output: Contribution to journalArticle

    6 Citations (Scopus)

    Abstract

    Objective: Axillary web syndrome (AWS) is known to occur after axillary dissection and has been reported after axillary sentinel lymph node biopsy (ASLNB) for breast cancer. However, the incidence and outcomes of AWS after ASLNB for melanoma are unknown. Methods: A retrospective review of prospectively collected, clinically node-negative patients undergoing ASLNB for melanoma at a single institution during a 14-year period was conducted to determine the incidence of AWS. Features pertaining to patients (age and gender), primary tumor (location, Breslow's depth), and nodes (number removed, positive node rate) were correlated with the occurrence of AWS. Results: Of the 465 patients undergoing ASLNB, 21 (4.5%) developed AWS postoperatively. In comparison, the incidence of other complications in this population were infection 3%, bleeding 1.5%, wound dehiscence .8%, lymphocele 5%, and lymphedema .4%. There was no statistical difference between patients with or without AWS in terms of tumor thickness, location of primary (upper extremity vs trunk), average number of sentinel nodes removed, positive SLNB rates (10% vs 12%), patient age, or gender. All cases of AWS resolved with expectant management; none required surgical intervention. Conclusions: AWS is a notable complication of ASLNB for melanoma, with an incidence as high or higher than "standard" complications. AWS should, therefore, be included in the preoperative discussion of possible complications of ASLNB. Traditional patient, tumor, and nodal factors are not predictive of AWS. Patients should be counseled that AWS usually responds to symptomatic treatment and resolves with time.

    Original languageEnglish (US)
    JournalAmerican Journal of Surgery
    DOIs
    StateAccepted/In press - Nov 3 2015

    Fingerprint

    Melanoma
    Sentinel Lymph Node Biopsy
    Biopsy
    Incidence
    cyhalothrin
    Lymphocele
    Neoplasms
    Lymphedema
    Upper Extremity
    Dissection
    Breast Neoplasms
    Hemorrhage
    Wounds and Injuries
    Infection

    Keywords

    • Axillary web syndrome
    • Melanoma
    • Mondor disease
    • Sentinel lymph node biopsy

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Axillary web syndrome : An underappreciated complication of sentinel node biopsy in melanoma. / Schuitevoerder, Darryl; White, Ian; Fortino, Jeanine; Vetto, John.

    In: American Journal of Surgery, 03.11.2015.

    Research output: Contribution to journalArticle

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    title = "Axillary web syndrome: An underappreciated complication of sentinel node biopsy in melanoma",
    abstract = "Objective: Axillary web syndrome (AWS) is known to occur after axillary dissection and has been reported after axillary sentinel lymph node biopsy (ASLNB) for breast cancer. However, the incidence and outcomes of AWS after ASLNB for melanoma are unknown. Methods: A retrospective review of prospectively collected, clinically node-negative patients undergoing ASLNB for melanoma at a single institution during a 14-year period was conducted to determine the incidence of AWS. Features pertaining to patients (age and gender), primary tumor (location, Breslow's depth), and nodes (number removed, positive node rate) were correlated with the occurrence of AWS. Results: Of the 465 patients undergoing ASLNB, 21 (4.5{\%}) developed AWS postoperatively. In comparison, the incidence of other complications in this population were infection 3{\%}, bleeding 1.5{\%}, wound dehiscence .8{\%}, lymphocele 5{\%}, and lymphedema .4{\%}. There was no statistical difference between patients with or without AWS in terms of tumor thickness, location of primary (upper extremity vs trunk), average number of sentinel nodes removed, positive SLNB rates (10{\%} vs 12{\%}), patient age, or gender. All cases of AWS resolved with expectant management; none required surgical intervention. Conclusions: AWS is a notable complication of ASLNB for melanoma, with an incidence as high or higher than {"}standard{"} complications. AWS should, therefore, be included in the preoperative discussion of possible complications of ASLNB. Traditional patient, tumor, and nodal factors are not predictive of AWS. Patients should be counseled that AWS usually responds to symptomatic treatment and resolves with time.",
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    AU - Vetto, John

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    N2 - Objective: Axillary web syndrome (AWS) is known to occur after axillary dissection and has been reported after axillary sentinel lymph node biopsy (ASLNB) for breast cancer. However, the incidence and outcomes of AWS after ASLNB for melanoma are unknown. Methods: A retrospective review of prospectively collected, clinically node-negative patients undergoing ASLNB for melanoma at a single institution during a 14-year period was conducted to determine the incidence of AWS. Features pertaining to patients (age and gender), primary tumor (location, Breslow's depth), and nodes (number removed, positive node rate) were correlated with the occurrence of AWS. Results: Of the 465 patients undergoing ASLNB, 21 (4.5%) developed AWS postoperatively. In comparison, the incidence of other complications in this population were infection 3%, bleeding 1.5%, wound dehiscence .8%, lymphocele 5%, and lymphedema .4%. There was no statistical difference between patients with or without AWS in terms of tumor thickness, location of primary (upper extremity vs trunk), average number of sentinel nodes removed, positive SLNB rates (10% vs 12%), patient age, or gender. All cases of AWS resolved with expectant management; none required surgical intervention. Conclusions: AWS is a notable complication of ASLNB for melanoma, with an incidence as high or higher than "standard" complications. AWS should, therefore, be included in the preoperative discussion of possible complications of ASLNB. Traditional patient, tumor, and nodal factors are not predictive of AWS. Patients should be counseled that AWS usually responds to symptomatic treatment and resolves with time.

    AB - Objective: Axillary web syndrome (AWS) is known to occur after axillary dissection and has been reported after axillary sentinel lymph node biopsy (ASLNB) for breast cancer. However, the incidence and outcomes of AWS after ASLNB for melanoma are unknown. Methods: A retrospective review of prospectively collected, clinically node-negative patients undergoing ASLNB for melanoma at a single institution during a 14-year period was conducted to determine the incidence of AWS. Features pertaining to patients (age and gender), primary tumor (location, Breslow's depth), and nodes (number removed, positive node rate) were correlated with the occurrence of AWS. Results: Of the 465 patients undergoing ASLNB, 21 (4.5%) developed AWS postoperatively. In comparison, the incidence of other complications in this population were infection 3%, bleeding 1.5%, wound dehiscence .8%, lymphocele 5%, and lymphedema .4%. There was no statistical difference between patients with or without AWS in terms of tumor thickness, location of primary (upper extremity vs trunk), average number of sentinel nodes removed, positive SLNB rates (10% vs 12%), patient age, or gender. All cases of AWS resolved with expectant management; none required surgical intervention. Conclusions: AWS is a notable complication of ASLNB for melanoma, with an incidence as high or higher than "standard" complications. AWS should, therefore, be included in the preoperative discussion of possible complications of ASLNB. Traditional patient, tumor, and nodal factors are not predictive of AWS. Patients should be counseled that AWS usually responds to symptomatic treatment and resolves with time.

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