Category: Cancer Rehabilitation; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : To discuss a case of truncal and upper extremity lymphedema and axillary web syndrome due to malignant melanoma
Design : A 49-year-old male presented with metastatic melanoma to left axillary lymph node. He underwent axillary lymph node dissection followed by radiation therapy and chemotherapy with Nivolumab. Approximately 3 weeks following ALND, patient developed painful left breast, axillary and truncal lymphedema, limited function and was unable to work. Initial examination showed edema of breast and lateral trunk with palpable fluid wave, minimally adherent scar and normal shoulder ROM with a PSFS score of 60-79% impairment. Months later, the patient developed a painful tendon in his arm and was diagnosed with axillary web syndrome (AWS) and lymphedema progressed to the upper extremity. The patient's therapy included manual lymphatic drainage, scar mobilization, mobilization of cording and wearing compression garments. Gradually, swelling, pain and cording reduced. Patient increased ability to exercise and was ultimately able to return to work full time at his heavy labor job after 9 months of diligent therapy.
Setting : n/a
Participants (or Animals, Specimens, Cadavers) : n/a
Interventions : n/a
Main Outcome Measure(s) : n/a
Results : Discussion:
Lymphedema following ALND is less common in the melanoma population than the breast cancer population. The incidence of truncal lymphedema and AWS following ALND in melanoma is unknown. This case demonstrates a male patient with malignant melanoma who develops truncal and breast lymphedema as well as AWS which responds well to treatment with OT.
Conclusions : Lymphedema and AWS are notable complications of ALND for melanoma which can significantly affect function and quality of life. Patients should be monitored for these complications and counseled appropriately.
Laura Prince– Resident Physician, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
Sara Christensen Holz– Associate Professor, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Lisa Dussault– Occupational Therapist, Advanced Clinician, Certified Lymphedema Therapist, UW Health Department of Orthopedics and Rehabilitation, Madison, Wisconsin