Regional control and morbidity after superficial groin dissection in melanoma

There is no consensus about the optimal extent of surgery for patients with melanoma metastases to inguinal nodes, and this is further complicated by variations in terminology for these dissections. In patients without clinical evidence of iliac metastases, we routinely perform a superficial groin dissection (SGD), which clears node-bearing tissue superficial to the fascia lata. We hypothesized that SGD provides regional tumor control comparable to published experience with deep groin dissection (DGD) and iliac and obturator dissection (IOD), but with less morbidity.

A retrospective review of a prospectively collected database evaluated patients undergoing SGD April 1994 through May 2008. Patients with clinical evidence of iliac metastases were excluded. Clinical and pathologic data regarding recurrence and survival were evaluated.

We identified 53 primary SGD: 27 for clinically palpable disease, and 25 for microscopic disease. Number and percentage of positive nodes were similar between groups. Median follow-up was 39 months, and 2 patients had primary recurrence in the groin (1 in each group). Two additional patients had concurrent groin and systemic recurrence. Ipsilateral groin recurrence rate prior to systemic disease was similar at 4% and 3.7% for microscopic and palpable disease, respectively. Similarly, survival was comparable between groups (82% and 73%). Toxicities were comparable to previously published data.

SGD provides regional control rates similar to DGD and IOD, for lymph node metastases clinically limited to the groin, whether occult or clinically evident.