Inguinal lymphadenectomy combined with staging endoscopic pelvic node sampling for stage III melanoma

Elective pelvic lymphadenectomy is one of the enduring controversies in the management of Stage III melanoma of the groin. It can provide valuable staging information but concerns remain over the possibility of increased morbidity without the benefit of increased survival. Endoscopic lymphadenectomy of the pelvic nodes is an established procedure in the management of urological and gynaecological malignancy but is relatively novel in the management of metastatic melanoma. An endoscopic approach reduces the risks suggested to be associated with the open procedure while still providing the clinician with the benefit of improved staging information. The authors present their experience of a combined procedure in a series of eight patients undertaken between January 2005 and May 2006 at the Exeter Melanoma Unit. One patient was discovered to harbour occult pelvic nodal metastases, despite a negative pre-operative CT scan. While no complications were directly attributable to the endoscopic procedure, the only major complication was post-operative lymphoedema which occurred in one case. The authors' experience suggests a combined procedure is both feasible and safe in the Plastic Surgery Department setting for the management of Stage III melanoma of the groin. This is the first documented UK experience of this technique.