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EDITOR—Gibson et al's experience of groin dissection compares favourably with the published data. Our preference for an oblique incision is based on an understanding of the blood supply to the groin; the vascular branches lie parallel to the natural skin creases within Camper's fascia, thus an oblique incision minimises their disruption.1Furthermore, we find that access to the femoral triangle is straightforward by using the oblique incision. We perform a sartorius transposition in order to provide femoral vessel coverage in the event of wound dehiscence or necrosis, not to reduce wound morbidity itself. Although possibly overcautious, in light of the high rate of wound complications reported in the literature, we consider this a simple and prudent measure. Cognisant that the evidence supporting long saphenous vein preservation is limited, we were mindful to indicate that this technique may reduce post-operative lymphoedema; it is not routinely performed in our unit.We concur with Gibson et al that femoral vessel skeletonisation clears the femoral triangle completely. This entails removal of the nodes that lie superficial to the deep fascia and also those that lie deep to this layer and medial to the femoral vein.Shamsian et al hint at the paradox between the UK guidelines for the management of malignant melanoma2—which say that sentinel lymph node biopsy should be offered in the context of a clinical trial—and the American Joint Committee on Cancer's staging system,3 which includes the presence of lymph node micrometastasis (positive on sentinel lymph node biopsy) as a staging criterion. The profound cost implications to the NHS of this procedure must be taken into account by the National Institute for Clinical Excellence when preparing its guidance.There is evidence for a survival benefit of sentinel lymph node biopsy,4 although the publication in 2006 of a large scale, multicentre, selective lymphadenectomy trial should definitively resolve this issue.5Footnotes Competing interests MCS and OCSC are investigators for the Oxford Tisseel (Baxter Healthcare, Newbury, United Kingdom) trial, a prospective randomised controlled trial to determine whether fibrin sealant can reduce post-operative complications following axillary and inguinal lymphadenectomy. They receive no financial remuneration for their work.

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