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Ali Hendi, MD; Peter T. Dorsher, MD; Thomas D. Rizzo Jr, MD; Lawrence E. Gibson, MD

Arch Dermatol. 2009;145(1):52-54.

Background  The immediate onset of severe postoperative pain, especially pain radiating distant from the incision site, is uncommon after dermatologic surgery.

Observation  A 37-year-old woman undergoing excision of a nevus from the left side of her midback had an exquisitely tender spot along the incision lines. This tender spot was hard to anesthetize and was clinically visible, after excision of the nevus, as a fibrous bundle in the subcutaneous plane. She presented in the immediate postoperative period with referred (distant) pain extending down the ipsilateral arm that was caused by a thoracic subcutaneous trigger point.

Conclusion  Surgeons and pain management specialists should be aware of this potential cause of immediate postoperative pain to prevent unnecessary medical or surgical interventions in the postoperative period.

Author Affiliations: Department of Dermatology (Dr Hendi) and Department of Physical Medicine and Rehabilitation (Drs Dorsher and Rizzo), Mayo Clinic, Jacksonville, Florida; and Department of Dermatology (Dr Gibson), Mayo Clinic, Rochester, Minnesota. Dr Hendi is now in private practice in Chevy Chase, Maryland.

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