Inguinal Lymph Node Dissection for Melanoma

An inguinal lymph node dissection (also known as a groin lymph node dissection) is the removal of lymph nodes and all tissue from the groin region that may contain tumors.

The human body contains lymph nodes in the neck, armpits, and inguinal region. Lymph nodes found in the groin are called inguinal nodes.

Melanoma can spread to the inguinal lymph nodes. If the nodes are enlarged and felt by yourself or your physician, or if nodes are found to harbor melanoma after a sentinel lymph node biopsy. 

If melanoma is found in a lymph node in this region, a lymph node dissection, or clearance within the groin, is recommended, with the goal of controlling the progression or return of the cancer. In general, if a patient is found to have melanoma within any lymph nodes, the recommended course of action is to remove them surgically.  You will see physical therapy prior to surgery in our preoperative lymphedema clinic and be instructed on exercises and measured for a compression garment.

Minimally Invasive Inguinal Lymph Node Dissection (MILND)

Fox Chase Cancer Center is one of only a few centers in the country that offers a minimally invasive approach to inguinal lymph node dissection.  This approach allows the procedure to be done through three small incisions, rather than a larger incision.  The incisions are lower in the leg, away from the groin crease with the hope of decreasing the risk of infection, postoperative complications, and less pain. The procedure takes about 1.5 hours to perform. 

What to Expect During a Lymph Node Groin Dissection

Before the surgery, your anesthesiologist will give you general anesthetic, so you will not be awake during the procedure. Once you are asleep, local anesthetic is injected into the area, to provide additional comfort after the procedure, which generally lasts 1-3 hours. During the operation, your surgeon will make an incision in the groin.  Staples or stitches are used to close the incision.

The intention of the operation is to remove all of the lymph nodes and associated tissue without causing damage to any nearby arteries, veins, and nerves. However, minor groin nerves exist that must be removed during the operation, which results in mild numbness in the upper thigh that is often permanent.

Sometimes, removal of the lymph nodes around the groin area, into the pelvis, is necessary. In order to do so a larger incision extending up toward the abdomen must be made. The muscles of the abdominal wall are opened for full visibility of the lymph nodes; this area is then repaired before closure of the surface wound.

Because any large wound produces fluid, a surgical drain (typically a soft, flexible silicone tube) is placed to collect the fluid. Homecare nurses will be arranged to check the drain and incision. You can expect the drain to remain in place for 3-4 weeks following the procedure.

Preparing for the Procedure

In addition to normal preparations for your surgery, you will also need to wear special stockings to prevent blood clots in the legs. Typically, an injection of heparin or clexane into the abdominal skin is performed to reduce the risk of blood clots.

After the Procedure

Your physician will keep you on bed rest 4-6 hours following surgery. You will likely stay in the hospital 1 or 2 nights and go home with the drain. Nursing staff will train you in the proper care and arrange for follow up before returning home. At the time of discharge, you will likely receive a prescription for pain medication. 

After 2-3 weeks, the stitches and/or staples will be removed. The scar in the groin will fade over time.

As with any surgical procedure, you will likely feel tired for a few weeks, and you should take a leave of 3-6 weeks from work to rest and heal. You should drive and resume normal activities once you feel fully in control again. Most patients do recover well from the procedure and resume all regular activities within 4-6 weeks.

After surgery, a pathologist will review and test the tissue that was removed from the groin. This detailed examination takes about 7-10 working days. The results will determine your follow-up care and whether further treatment is necessary.

Regular post-operative checks are recommended to check the healing progression and look for any signs of a possible melanoma recurrence. The surgery taken place will help to prevent the melanoma from progression in the groin area. However, because the melanoma could spread to other regions within the body, ongoing, regular follow up is recommended.

Possible Side Effects

Most patients recover from the surgery well without any major issues. Some common side effects, however, may include fluid collection in the groin and minor wound infection. These problems are simple to manage and do not typically require readmission to the hospital.  The most common side effect is lymphedema and this occurs in approximately 20% of patients.  If it occurs it can be months or years after the procedure. 

Below is a comprehensive listing of possible side effects in the early and later stages:

Common Side Effects

• Numbness around the wound and in the upper thigh
• Minor wound infection
• Small amount of blood collection or lymph fluid collection (known as seroma)
• Possible constipation if a more extensive procedure involving removal of the nodes in the pelvis is undertaken, making it uncomfortable to eat solids for 2-3 days following the procedure (fluids only may be recommended until the bowels function regularly again)
• Prominent scar at site of incision
• Numbness around wound and in the inner thigh
• Small seroma (fluid collection) in wound
• Lymphedema (swelling of the leg)

Less Common Side Effects

• Excessive bleeding needing re-operation
• Major wound infection requiring re-operation
• Deep vein thrombosis (clots in the veins in the legs)
• Pulmonary embolism (lung clots)
• Damage to blood vessels and nerves supplying muscles
• Chest infection
• Large seroma (fluid collection) requiring repeated drainage or new drain insertion
• Neuralgia in the leg or groin