The superficial nodes are localized at least 5 cm above the inguinal ligament in the entire femoral triangle and spread on both sides of the great saphenous vein. Except for in very thin people, these lymph nodes are located under scarpa's fascia.
A vertical lazy-S incision is made starting 10 cm above the inguinal ligament, crosses the midpoint, and continues about 15 cm below the inguinal ligament . Alternatively, an incision is made a few centimeters below and parallel to the inguinal ligament and curved medially down in the femoral triangle.
- The skin flaps are dissected and the specimen is removed en bloc. The great saphenous vein is included in the specimen from the tip of the femoral triangle to the origin into the femoral vein. If metastatic lymph nodes are confirmed in the pelvis, the operation is extended to an ilio-inguinal dissection including iliac and obtural nodes.
- The wound is washed and a drain is installed.
- The wound is closed in two layers.
The incision is often made horizontally, lazy-S, or zig-zag, and extends from the lateral edge of the major pectoral muscle to the edge of the latissimus dorsi. An upper and lower skin flap is created. All 6 node groups are situated under the clavipectoral fascia, and an en bloc removal is performed. The axilla dissection should include levels 1, 2, and 3 .
To obtain sufficient access to the top of the axilla, it may be necessary to split the minor pectoral muscle by the coracoid process or remove it. It is rarely necessary to split the major pectoral muscle. The axillary vein can, if absolutely necessary, be removed since intact blood supply around the scapula prevents permanent stasis in the arm. The dissection continues down to the 6th rib while trying to conserve the large nerves in the area (the thoracodorsal and long thoracic nerves).
Neck dissections for malignant melanoma have changed in character in recent years. Selective and modified radical neck dissections are now performed more frequently. Which levels are dissected depend on the location of the primary tumor.
A neck dissection is a technically difficult operation with a high risk of complications and high relapse frequency. This type of operation should be centralized.