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What does a painful mass in the groin indicate?

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Practicing since : 2004
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good morning, patient is 52, white male. he was diagnosed with melanoma a year ago, had surgery removed..this past dec., he was having pain in the groin area, thought he had a hernia but to make the story short, it is a mass..they have done 2 biopsy and both came back inconclusive..this mass is pushing on his artery and veins in the groin area causing severe pain..he has been in West XXXXXXX hospital for 2 wks. they have him on major pain meds they are trying to relieve as much pain as possible so he would be able to lay flat on his back to start radiation, but it has failed..they tryed yesterday to do a epidural catherter it failed there anything else I can suggest trying on him,? they have a pain mgmt team working on this but the epidural catherter was failed..he is so frustrated, please help also i forgot, he is on heparin also due to blood clot in left leg, same side where the mass is..blood clot showed up after the 2nd biopsy all biopsy came back inconclusive..the 2nd one they put him under anesthesia..still nothing showing..I do know with the first biopsy, the physician that did it, all she could get out of it was a syringe of blood, no tissue..she thought it was a hematoma..any advice or options would be greatly appreciated..thank you
Posted Tue, 4 Mar 2014 in Cancer
Answered by Dr. Indranil Ghosh 35 minutes later
Brief Answer: Please refer below Detailed Answer: Hi Thanks for your query. As it is a mass in the groin which is causing so much pain (and I assume the melanoma was in the same limb), it is most likely metastatic melanoma in the lymph node. Were the lymph nodes in that area dissected at the time of initial surgery? Now, if it is recurrent melanoma, we need to prove it by biopsy unfortunately. Otherwise it is just presumptive. We also need to see if it has spread to other sites like chest. Even if it is localized to that area, I don't think radiotherapy will give him benefit. There are newer therapies like immunotherapies, which may do better. Other pain control options are opioids like morphine or fentanyl. The blood clot also points to a diagnosis of recurrent cancer. Hope I have answered your query. I will be available to answer further followup queries, if any.
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Follow-up: What does a painful mass in the groin indicate? 14 minutes later
they did a pet scan from head to feet and only a little piece of the mass lite up..nothing else anywhere else..he has a team on specailist working on him and states that he needs 10 days of radiation but he can not lay still long enough, i was hoping you would have some suggestion on how to releive the pain there any other way other than meds and the epidural catherter?? what would you do if this was your patient? today technology there has to be an answer
Answered by Dr. Indranil Ghosh 2 hours later
Brief Answer: Unfortunately technology has limited role here Detailed Answer: It is mostly upto the meds now. There is no theoretical limit to increasing the dose of opioids and I am sure pain will get controlled in a few days. If he was my patient I would increase the dose of opioids and hope for the best. Regards.
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