Deep Groin (Iliac/Obturator Node) Dissection

Abstract

This chapter will summarize the indications, surgical technique, and anatomic considerations, and morbidity and outcomes for an iliac/obturator node dissection. While the focus will be on melanoma, certainly cutaneous malignancies of other histologies (e.g., squamous cell carcinoma, Merkel cell carcinoma) can affect the nodes in the deep pelvis. Decision and timing for surgery will ultimately be influenced by the availability of other effective therapeutic modalities and by patient factors, but the principles of surgical technique for the dissection are generally applicable. In most situations, the deep groin dissection is performed in the context of a superficial node dissection, in which case the authors favor a single skin incision to be used to perform the combined (radical) groin dissection (see Chap. 26). Less commonly, for metachronous disease or from metastatic disease from certain truncal anatomic sites (whose lymphatic drainage can occur directly to the pelvis), the deep groin dissection is performed in isolation.