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

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.

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.

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.

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.