Analyzing Lymphadenectomy Morbidity in Stage III Melanoma: A Single-Center Perspective

A single-center cohort of 185 patients found that therapeutic lymphadenectomy for stage III melanoma carries basin-specific morbidity, with substantially higher groin (inguinal/ilio-obturator) wound complications after inguinal dissection.

This retrospective single-center cohort included 185 consecutive patients with stage III melanoma who underwent therapeutic nodal dissection from January 2004 to August 2025. The team compared pre- and post–MSLT-II eras, recorded 90‑day postoperative surgical-field complications, basin-specific outcomes, and survival endpoints, and used univariate tests plus multivariable Cox models for survival and Firth’s penalized logistic regression for rare-event complications to generate bias‑corrected odds estimates.

In this cohort, inguino-iliac-obturator lymphadenectomy was associated with the highest odds of wound dehiscence and surgical-site infection. Overall surgical-field complications occurred in 16.8% (31/185); inguinal dissections had a 29.6% complication rate (21/71) versus 9.2% after axillary dissection (10/109). Inguinal persistent seroma occurred in 7.0% (5/71), wound dehiscence in 19.7% (14/71), and surgical-site infection in 8.5% (6/71), compared with axillary dehiscence 4.6% (5/109) and infection 0.9% (1/109).

In multivariable models, inguinal dissection carried higher adjusted odds: overall complications OR 4.03 (95% CI 1.79–9.09; p=0.001), wound dehiscence OR 4.79 (95% CI 1.70–13.46; p=0.003), and infection OR 7.18 (95% CI 1.18–43.5; p=0.032). These findings support basin-specific risk stratification and tailoring of the surgical approach.

Unadjusted analyses linked postoperative complications with worse melanoma-specific survival: Kaplan–Meier MSS was 82% at 1 year, 55% at 5 years, and 49% at 10 years, with a significant separation by complication status on log-rank testing (p<0.001).

After adjustment for age, nodal burden/tumor-load proxies, and treatment era, multivariable Cox models did not confirm an independent association between complications and adjusted melanoma-specific outcomes; the crude survival signal was driven by infection and dehiscence but lost significance after adjustment. In short, complications correlated with worse crude survival but did not demonstrate a clear independent survival effect in this cohort.

Key Takeaways:

• In this 185-patient single-center series, basin-specific inguinal (inguino-iliac-obturator) dissection carried a distinct morbidity profile that can inform preoperative counseling and operative planning.
• Complications clustered by anatomic basin, suggesting that tailoring the extent of dissection by basin may reduce morbidity while preserving nodal-staging accuracy.
• These basin-level differences warrant incorporation into preoperative decision-making and may guide surveillance intensity and selective use of therapeutic lymphadenectomy in the modern era.