Annals of Surgical Oncology

, Volume 20, Issue 6, pp 2049–2055

Wound Complications after Inguinal Lymph Node Dissection for Melanoma: Is ACS NSQIP Adequate?

  • Carly E. Glarner
  • David Y. Greenblatt
  • Robert J. Rettammel
  • Heather B. Neuman
  • Sharon M. Weber



In the treatment of melanoma, inguinal lymph node dissection (ILND) is the standard of care for palpable or biopsy-proven lymph node metastases. Wound complications occur frequently after ILND. In the current study, the multicenter American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was utilized to examine the frequency and predictors of wound complications after ILND.


Patients with cutaneous melanoma who underwent superficial and superficial with deep ILND from 2005-2010 were selected from the ACS NSQIP database. Standard ACS NSQIP 30-day outcome variables for wound occurrences—superficial surgical site infection (SSI), deep SSI, organ space SSI, and disruption—were defined as wound complications.


Of 281 total patients, only 14 % of patients had wound complications, a rate much lower than those reported in previous single institution studies. In a multivariable model, superficial with deep ILND, obesity, and diabetes were significantly associated with wound complications. There was no difference in the rate of reoperation in patients with and without wound complications.


ACS NSQIP appears to markedly underreport the actual incidence of wound complications after ILND. This may reflect the program’s narrow definition of wound occurrences, which does not include seroma, hematoma, lymph leak, and skin necrosis. Future iterations of the ACS NSQIP for Oncology and procedure-specific modules should expand the definition of wound occurrences to incorporate these clinically relevant complications.


  1. 1.
    Howlader N NA, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute, 1975-2009 (Vintage 2009 Populations).Google Scholar
  2. 2.
    Chang SB, Askew RL, Xing Y, et al. Prospective assessment of postoperative complications and associated costs following inguinal lymph node dissection (ILND) in melanoma patients. Ann Surg Oncol. 2010;17(10):2764-72.PubMedCrossRefGoogle Scholar
  3. 3.
    Coit DG, Rogatko A, Brennan MF. Prognostic factors in patients with melanoma metastatic to axillary or inguinal lymph nodes: a multivariate analysis. Ann Surg. 1991;214(5):627-36.PubMedCrossRefGoogle Scholar
  4. 4.
    Serpell JW, Carne PW, Bailey M. Radical lymph node dissection for melanoma. ANZ J Surg. 2003;73(5):294-9.PubMedCrossRefGoogle Scholar
  5. 5.
    American College of Surgeons National Surgical Quality Improvement Program. Available at: Accessed 10 Nov 2011.
  6. 6.
    Centers for Disease Control and Prevention. Surgical Site Infection (SSI) Event. Available at: Accessed 27 Jan 2012.
  7. 7.
    Guggenheim MM, Hug U, Jung FJ, et al. Morbidity and recurrence after completion lymph node dissection following sentinel lymph node biopsy in cutaneous malignant melanoma. Ann Surg. 2008;247(4):687-93.PubMedCrossRefGoogle Scholar
  8. 8.
    de Vries M, Vonkeman WG, van Ginkel RJ, et al. Morbidity after inguinal sentinel lymph node biopsy and completion lymph node dissection in patients with cutaneous melanoma. Eur J Surg Oncol. 2006;32(7):785-9.PubMedCrossRefGoogle Scholar
  9. 9.
    Hughes TM, A’Hern RP, Thomas JM. Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma. Br J Surg. 2000;87(7):892-901.PubMedCrossRefGoogle Scholar
  10. 10.
    Karakousis CP, Driscoll DL. Groin dissection in malignant melanoma. Br J Surg. 1994;81(12):1771-4.PubMedCrossRefGoogle Scholar
  11. 11.
    Beitsch P, Balch C. Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection. Am J Surg. 1992;164(5):462-5; discussion 465-6.PubMedCrossRefGoogle Scholar
  12. 12.
    Shaw JH, Rumball EM. Complications and local recurrence following lymphadenectomy. Br J Surg. 1990;77(7):760-4.PubMedCrossRefGoogle Scholar
  13. 13.
    Poos HP, Kruijff S, Bastiaannet E, et al. Therapeutic groin dissection for melanoma: risk factors for short term morbidity. Eur J Surg Oncol. 2009;35(8):877-83.PubMedCrossRefGoogle Scholar
  14. 14.
    Sabel MS, Griffith KA, Arora A, et al. Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery. 2007;141(6):728-35.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Carly E. Glarner
    • 1
  • David Y. Greenblatt
    • 1
  • Robert J. Rettammel
    • 1
  • Heather B. Neuman
    • 1
  • Sharon M. Weber
    • 1
  1. 1.Department of SurgeryUniversity of WisconsinMadisonUSA

Personalised recommendations