Melanoma and Pain: Understanding the Connection

Melanoma and Pain: What Patients and Survivors Need to Know

Melanoma and Pain: What Patients and Survivors Need to Know. Melanoma and pain are not necessarily connected. In fact, many people diagnosed with early-stage melanoma have little or no pain from the cancer itself. Melanoma is often discovered because a mole or skin lesion changes in size, shape, color, or appearance—not because it hurts.

But pain can become part of the melanoma experience.

Pain may result from:

The melanoma itself
Melanoma surgery
Sentinel lymph node biopsy or lymph node surgery
Nerve damage
Metastatic melanoma
Bone metastases
Immunotherapy
Targeted therapy
Radiation therapy
Persistent treatment-related side effects

And for melanoma survivors, pain can sometimes continue long after active treatment ends.

The important message is this:

New or persistent pain does not automatically mean that melanoma has returned or spread—but unexplained pain deserves evaluation.

The National Cancer Institute explains that cancer pain may come from the cancer itself or from treatments such as surgery, radiation, medications, or treatment-related nerve damage.

At PeopleBeatingCancer, I believe that patients should understand both conventional pain management and evidence-based complementary therapies that may help control symptoms and improve quality of life.

For a broader discussion, see my guide to Cancer and Pain: What Patients Need to Know.

I am a long-term survivor of an incurable blood cancer called multiple myeloma.

Though I have been in complete remission from my blood cancer since 1999, I vividly remember the pain caused by my cancer. Also, I have developed long-term side effects that cause joint, muscle, nerve, and bone pain. I spend as much time and money managing my therapy-induced pain as I do managing my health. I hope the post below helps you manage your own cancer pain.

Like most topics on PeopleBeatingCancer.org, I believe that patient education is the key to managing a problem.

Scroll down and post a question or comment if you’d like to know anything about cancer and pain.

Good luck,

David Emerson

Concepts Central to Managing Your Cancer

Cancer and Pain:

Does Melanoma Cause Pain?

Usually not in its earliest stages.

The classic warning signs of melanoma are visual changes in the skin—a new lesion or an existing mole that changes in size, shape, or color. The American Cancer Society emphasizes these changes, rather than pain, among the major warning signs of melanoma.

This means that the absence of pain should never be interpreted as the absence of melanoma.

As melanoma becomes more advanced, however, pain may occur because tumors affect surrounding tissues or because melanoma spreads elsewhere in the body.

The National Cancer Institute notes that stage IV melanoma may spread to areas including the:

Brain
Spinal cord
Bone
Lung
Liver
Gastrointestinal tract
Muscle and other soft tissues
Distant lymph nodes

Where melanoma spreads can determine what kind of pain or other symptoms develop.

1. Pain From the Melanoma Itself

A melanoma lesion can occasionally become:

Tender
Sore
Inflamed
Ulcerated
Bleeding
Irritated
Painful

But pain is not a reliable way to determine whether a skin lesion is melanoma.

A suspicious lesion should be evaluated because of its appearance and evolution—not simply because it hurts or doesn’t hurt.

2. Pain After Melanoma Surgery

Surgery remains a cornerstone of melanoma treatment.

For localized melanoma, this commonly means wide local excision, in which the melanoma and a margin of surrounding normal tissue are removed. Some patients also undergo sentinel lymph node biopsy. More extensive surgery may sometimes be necessary.

Most postoperative pain improves as tissues heal.

However, a small percentage of melanoma patients develop persistent pain.

One study of melanoma surgery survivors found that approximately 8.6% reported chronic pain in the scar area. Abnormal sensations were considerably more common, and the researchers concluded that neuropathic pain should be considered in patients experiencing persistent postoperative pain.

This is an important survivorship issue.

Pain around a melanoma surgical scar may feel like:

Burning
Tingling
Shooting
Electric sensations
Numbness
Tenderness
Hypersensitivity
Aching

These symptoms can suggest that nerves were affected during surgery.

For a broader explanation of cancer surgery and recovery, see Surgery for Cancer: What Patients Need to Know.

3. Pain After Sentinel Lymph Node Biopsy or Lymph Node Dissection

Melanoma patients sometimes undergo lymph node procedures to determine whether the cancer has spread.

These procedures can injure or irritate sensory nerves.

A review examining melanoma patients who underwent sentinel lymph node biopsy or complete lymph node dissection found persistent postoperative pain in a minority of patients, with higher reported rates following more extensive lymph node dissection. Neuropathic mechanisms appeared to account for much of the persistent pain reported in the studies that characterized pain type.

This means that pain following lymph node surgery may not simply be a matter of the incision taking longer to heal.

It can be nerve pain.

That distinction matters because neuropathic pain may respond differently from ordinary inflammatory or musculoskeletal pain.

PeopleBeatingCancer has additional information about neuropathic pain and its treatment.

4. Pain From Metastatic Melanoma

Pain becomes more important when melanoma spreads beyond its original location.

Metastatic melanoma can involve the bones, brain, spinal cord, gastrointestinal tract, lungs, liver, soft tissues, and other organs.

Symptoms depend greatly on the location of metastases.

Bone metastases

Melanoma that spreads to bone may cause:

Persistent deep aching
Localized tenderness
Pain during movement
Nighttime pain
Sudden severe pain if a weakened bone fractures

The NCI describes metastatic bone pain as commonly deep and throbbing, sometimes accompanied by episodes of more intense pain triggered by movement.

Radiation therapy can sometimes be used specifically to reduce pain from bone metastases.

Brain or spinal metastases

Pain may sometimes appear as:

Persistent or unusual headaches
Neck or back pain
Pain associated with neurological symptoms

Symptoms involving the nervous system require particular attention.

New pain accompanied by weakness, numbness, difficulty walking, confusion, seizures, vision changes, or bowel or bladder dysfunction should be evaluated promptly.

The NCI specifically lists radiation to the brain, spinal cord, or bone among palliative treatment options for advanced melanoma.

5. Immunotherapy Can Cause Pain Too

This is especially important for melanoma patients.

Checkpoint inhibitors such as:

Pembrolizumab (Keytruda)
Nivolumab (Opdivo)
Ipilimumab (Yervoy)
Nivolumab plus relatlimab

have transformed the treatment of advanced melanoma.

But immunotherapy works by activating the immune system, and that activation can sometimes cause inflammation in healthy tissues.

Pain-related immune adverse events can include:

Joint pain
Muscle pain
Arthritis-like symptoms
Headaches
Abdominal pain
Neurological pain
Pain associated with inflammation of organs or tissues

Some immune-related adverse events can become serious.

For this reason, new pain during immunotherapy should not automatically be treated at home with supplements, NSAIDs, herbs, or other remedies without discussing the symptom with the oncology team.

Pain Does Not Automatically Mean Your Melanoma Has Returned

For survivors, this may be one of the most important points in this article.

A melanoma survivor who develops back pain, joint pain, headaches, or nerve pain may understandably wonder:

Has my melanoma come back?

Sometimes pain can be associated with recurrent or metastatic disease.

But there are many other possibilities.

Pain can result from:

Previous surgery
Scar tissue
Nerve injury
Immunotherapy
Musculoskeletal problems
Arthritis
An old injury
Other medications
Aging
Conditions completely unrelated to melanoma

Therefore, pain alone cannot tell you whether melanoma has recurred.

The better approach is:

New + unexplained + persistent or worsening pain = something worth discussing with your healthcare team.

The NCI similarly recommends contacting the medical team about new pain or pain that is not improving with the current pain-control plan.

How Is Melanoma-Related Pain Treated?

The most effective treatment depends on what is causing the pain.

This distinction is essential.

Treating bone metastasis is different from treating postoperative nerve pain.

Treating inflammatory joint pain caused by immunotherapy is different from treating ordinary arthritis.

Treatment may therefore involve several layers.

Treating the Cause of the Pain

When possible, treating the melanoma itself may reduce pain.

Depending on the patient’s situation, this might involve:

Surgery
Immunotherapy
Targeted therapy
Radiation
Other systemic therapy

For advanced melanoma, treatment directed at painful metastases may sometimes be used specifically to improve symptoms and quality of life.

Conventional Pain Management

Depending on the cause and severity of pain, clinicians may consider:

Acetaminophen

May help mild pain, although liver disease and other medical conditions can affect whether it is appropriate.

NSAIDs

Drugs such as ibuprofen or naproxen may reduce inflammatory and musculoskeletal pain.

However, NSAIDs aren’t appropriate for everyone—particularly patients with certain kidney, cardiovascular, gastrointestinal or bleeding risks.

Neuropathic pain medications

Burning, shooting or electric-like pain may require medications directed specifically at nerve pain rather than ordinary analgesics.

Opioids

Moderate or severe cancer pain may sometimes require opioids.

The NCI includes opioids among the established medications used for moderate-to-severe cancer pain.

Radiation therapy

Radiation may be especially useful when melanoma has spread to painful areas such as bone, brain or spinal structures.

Palliative care

Palliative care does not mean giving up on cancer treatment.

It can be provided alongside active melanoma therapy and can help manage:

Pain
Fatigue
Sleep problems
Anxiety
Loss of appetite
Other symptoms affecting quality of life

Evidence-Based Complementary Therapies for Cancer Pain

Pain management does not necessarily have to rely on medication alone.

The Society for Integrative Oncology and American Society of Clinical Oncology developed an evidence-based guideline specifically addressing integrative approaches to cancer pain.

After reviewing more than 200 relevant studies, the expert panel concluded that several complementary therapies can be considered in appropriate circumstances.

Acupuncture

The SIO-ASCO guideline states that acupuncture may be offered for general cancer pain or musculoskeletal pain.

Acupressure or reflexology

These approaches may be considered for some patients experiencing pain during systemic cancer therapy.

Massage

Massage may be useful for pain in some patients receiving palliative or hospice care.

Massage around melanoma surgical sites, lymph node surgery, lymphedema or known metastases should first be discussed with the healthcare team.

Mindfulness, meditation and guided imagery

These strategies may help some patients cope with pain and reduce the distress surrounding chronic pain.

The NCI includes meditation, mindfulness, guided imagery, hypnosis and other non-drug approaches among integrative strategies that may be incorporated into an individualized cancer pain plan.

Exercise and physical therapy

Appropriately prescribed movement may help maintain:

Strength
Mobility
Balance
Joint function
Independence

But exercise needs to be individualized—particularly when melanoma has spread to bone or when surgery, neurological symptoms or other complications affect physical function.

PeopleBeatingCancer Evidence Rating

Therapy	Potential Role	PBC Evidence Rating
Treating the underlying melanoma	Pain caused directly by tumor burden	Strong
Palliative radiation	Painful bone/brain/spinal metastases	Strong
Standard analgesic medications	Cancer-related pain	Strong
Neuropathic-pain medications	Postsurgical/nerve pain	Moderate–Strong
Acupuncture	General cancer or musculoskeletal pain	Moderate
Acupressure/reflexology	Pain during systemic therapy	Moderate
Massage	Selected palliative-care patients	Moderate
Mindfulness/meditation	Pain coping and symptom burden	Moderate
Exercise/physical therapy	Function and selected musculoskeletal pain	Moderate
Supplements for melanoma pain	Evidence varies greatly by product	Limited/Insufficient

PBC interpretation: Evidence ratings describe the strength of available research—not whether a therapy is appropriate for a particular patient. Complementary therapies should supplement appropriate melanoma treatment and medical pain management rather than replace them.

A Special Warning About Supplements During Melanoma Immunotherapy

Melanoma patients should be especially careful about assuming that a supplement described as “anti-inflammatory,” “immune boosting,” or “natural” is automatically beneficial.

Immunotherapy deliberately alters immune activity.

Some supplements may:

Affect immune signaling
Interact with medications
Influence bleeding
Affect the liver or kidneys
Complicate interpretation of treatment side effects

And symptoms attributed to a supplement or ordinary inflammation could actually represent an immune-related adverse event requiring medical treatment.

If you are receiving Keytruda, Opdivo, Yervoy or another checkpoint inhibitor, tell your oncology team about every supplement, herb, mushroom product, cannabinoid, and over-the-counter medication you use.

When Should a Melanoma Patient Call the Doctor About Pain?

Contact your healthcare team about:

New unexplained pain
Pain that persists
Pain that steadily worsens
New bone pain
Severe nighttime pain
New or unusual headaches
Pain accompanied by weakness
Numbness or tingling
Difficulty walking
Pain near a previous melanoma site
Persistent surgical-site pain
Significant new joint or muscle pain during immunotherapy
Pain that interferes with sleep or daily activities

Seek urgent medical evaluation for severe neurological symptoms such as sudden weakness, seizures, confusion, loss of bowel or bladder control, or rapidly worsening symptoms.

Questions to Ask Your Oncologist

What do you think is causing my pain?
Could this be related to my melanoma?
Could it be a long-term effect of melanoma surgery?
Does the pain sound neuropathic?
Could my immunotherapy or targeted therapy be causing it?
Do I need imaging?
Could melanoma have affected my bones or nerves?
Would radiation help if the pain is caused by metastasis?
Should I see a pain-management or palliative-care specialist?
Would physical therapy help?
Could acupuncture or another integrative therapy be appropriate?
Are any supplements I take likely to interact with my melanoma treatment?

The Bottom Line

Melanoma does not necessarily cause pain.
Early melanoma is often painless.

But melanoma patients and survivors can develop pain from several sources:

Melanoma itself → surgery → lymph node procedures → nerve injury → metastatic disease → immunotherapy → radiation → other unrelated health problems.

That is why the most important question isn’t simply:

“How do I stop the pain?”

It is:

“What is causing my pain?”

Once the cause is understood, patients and their healthcare teams can build a more rational treatment plan.

That plan might combine treatment of the melanoma itself with medications, radiation, physical therapy, palliative care, and selected evidence-based complementary therapies.

And melanoma survivors should remember one particularly important distinction:

Pain does not automatically mean recurrence—but new, unexplained, or worsening pain deserves to be evaluated.

For more information about managing pain across cancer types, read Cancer and Pain: What Patients Need to Know.

Research and References

National Cancer Institute — Pain and Cancer
https://www.cancer.gov/about-cancer/treatment/side-effects/pain

National Cancer Institute — Melanoma Treatment (PDQ), Patient Version
https://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq

National Cancer Institute — Cancer Pain (PDQ)
https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-pdq

American Cancer Society — Melanoma: Early Detection, Diagnosis and Staging
https://www.cancer.org/cancer/types/melanoma-skin-cancer/detection-diagnosis-staging.html

Høimyr et al. — Persistent Pain After Surgery for Cutaneous Melanoma
https://pubmed.ncbi.nlm.nih.gov/21904198/

Gärtner et al. — Persistent Postoperative Pain and Sensory Changes Following Lymph Node Excision in Melanoma Patients
https://pubmed.ncbi.nlm.nih.gov/24346167/

Mao et al. — Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline
https://pubmed.ncbi.nlm.nih.gov/36122322/

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