Inguinal Lymph Node Dissection
What the Examiner Expects
Surgical removal of inguinal lymph nodes for regional metastatic disease, most commonly for melanoma, squamous cell carcinoma, or vulvar/penile cancer. The dissection encompasses the superficial inguinal nodes (within the femoral triangle) and may include deep (iliac/obturator) nodes. The examiner expects you to know the anatomic boundaries (inguinal ligament superiorly, adductor longus medially, sartorius laterally, femoral artery/vein deep), identify and preserve the femoral nerve, and understand the high morbidity: wound complications occur in 30–50% (seroma, lymphocele, skin necrosis, infection) and chronic lymphedema is common.
Key Examiner Focus Points
- Indications: melanoma with positive inguinal SLN (if CLND indicated), squamous cell carcinoma metastases, vulvar/penile cancer
- Boundaries: inguinal ligament (superior), adductor longus (medial), sartorius (lateral)
- Femoral vessels are the deep boundary — preserve the femoral nerve
- Saphenous vein preservation may reduce lymphedema
- High wound complication rate: seroma, lymphocele, wound dehiscence, lymphedema (30–50%)
Common Curveballs
Postop a large lymphocele develops in the inguinal region
Serial percutaneous aspiration initially. If recurrent, consider sclerotherapy or placement of a drain. Compression garments can help. Persistent lymphoceles may require marsupialization or excision. Sartorius muscle flap transposition at the time of dissection can help reduce wound complications.
Melanoma SLN biopsy in the groin is positive — should you do CLND?
Per MSLT-II trial, observation with ultrasound surveillance is a safe alternative to completion lymph node dissection for microscopic SLN disease. CLND may be considered for high-volume nodal metastasis, extranodal extension, or if reliable surveillance is not feasible. Discuss at multidisciplinary tumor board.
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