Melanoma

Possible complications include wound infection and/or bleeding, damage to underlying tendons or neurovascular structures, and symptoms relating to the surgical scar.

Possible complications include those for excision, with the complexity and risk of the procedure relating to the anatomical location. The risk of complications relating to altered anatomy of the nodal basin (e.g., lymphoedema) is low.

Post-operative lymphoedema, wound infection, haematoma, and seroma.

Local recurrence rates (defined as recurrence within 2 cm of the surgical scar from the primary melanoma) vary according to stage of melanoma.

Recurrence rates are 1% to 2% for stage I melanomas (≤1 mm thick), but nearly 30% for stage II melanomas (>1 mm thick).[182]MacKenzie Ross AD, Haydu LE, Quinn MJ, et al. The association between excision margins and local recurrence in 11,290 thin (T1) primary cutaneous melanomas: a case-control study. Ann Surg Oncol. 2016 Apr;23(4):1082-9. http://www.ncbi.nlm.nih.gov/pubmed/26561405?tool=bestpractice.com [183]Berger AC, Ollila DW, Christopher A, et al. Patient symptoms are the most frequent indicators of recurrence in patients with American Joint Committee on Cancer stage II melanoma. J Am Coll Surg. 2017 Apr;224(4):652-9. http://www.ncbi.nlm.nih.gov/pubmed/28189663?tool=bestpractice.com

Symptoms of metastases depend on the organ involved and include headache, vision changes, seizures, and weakness (brain metastasis); chest pain, cough, haemoptysis (lung metastasis); abdominal pain, melaena (gastrointestinal metastasis); jaundice (liver metastasis); pain, fracture (bone metastasis).

Immune-related adverse events (IRAEs) are a recognised complication of treatment with immune checkpoint inhibitors. Skin, gut, lung, endocrine, and musculoskeletal IRAEs are relatively common. Renal, cardiovascular, neurological, haematological, and ophthalmological IRAEs are well recognised, but occur much less frequently.

The majority of IRAEs are mild to moderate in severity, but they can be life-threatening (e.g., severe colitis, myocarditis, pneumonitis, toxic epidermal necrolysis, encephalitis, and autoimmune type I diabetes mellitus presenting as diabetic ketoacidosis).[184]Brahmer JR, Abu-Sbeih H, Ascierto PA, et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer. 2021 Jun;9(6):e002435. https://jitc.bmj.com/content/9/6/e002435.long http://www.ncbi.nlm.nih.gov/pubmed/34172516?tool=bestpractice.com Prompt recognition and management of toxicity is essential.

Chemotherapy frequently causes malaise, nausea, gastrointestinal symptoms, or bone marrow suppression.

Complications of radiotherapy are variable (relatively low for gamma knife radiosurgery; relatively high for whole-brain irradiation, including radiation-induced oedema and tissue necrosis).