The advent of immune checkpoint inhibitors (ICIs) including anti-PD-1 (pembrolizumab and nivolumab) and anti-CTLA-4 (ipilimumab) antibodies drastically changed treatment modalities for patients with various kinds of cancers, including lung cancer, 1 breast cancer, 2 oesophageal cancer, 3 urothelial cancer, 4 cervical cancer, 5 endometrial cancer, 6 renal cell carcinoma, 7,8 head and neck cancer, 9 Hodgkin lymphoma, 10 high microsatellite instability/ mismatch repair-deficient cancer, 11,12 tumour mutational burden (TMB)-high solid cancer, 13 and melanoma, 14,15 in advanced and/or adjuvant stage. ICIs are commonly used for treating advanced cutaneous melanoma (CM). In the phase III KEYNOTE-006 clinical trial, pembrolizumab resulted in an objective response rate (ORR) of 42% and a longer overall survival (OS) than ipilimumab (median OS: 32.7 months vs. 15.9 months; p < 0.001). 16 Likewise, the randomized phase III CheckMate-067 clinical trial demonstrated that nivolumab plus ipilimumab resulted in a better ORR and prolonged survival than nivolumab alone (ORR, 58% vs. 45%; median progression-free survival (PFS), 11.5 months vs. 6.9 months; median OS, not reached vs. 36.9 months). 17 Moreover, the 5-year OS has improved from <10% in patients with advanced stage CM treated with conventional chemotherapy, such as dacarbazine, to 30%-50%, especially in patients treated with anti-PD-1 antibody alone or in combination with ipilimumab. 16,18,19 CM is predominantly manifested in the sun-exposed skin of the Caucasian population. 20 However, melanomas rarely

Skin cancer patients with clinical nodal disease or whose positive sentinel nodes had great tumor burden remain candidates for regional lymph node dissections. Among these patients, inguinal or ilioinguinal lymph node dissection is frequently required in clinical practice, which is associated with significant postoperative morbidity—including lymphatic leakage. The aim of this retrospective study was to evaluate the efficacy of LigaSure™, an electrothermal bipolar vessel sealing system, in reducing lymphatic leakage in inguinal or ilioinguinal lymph node dissection. In total, 58 patients who received inguinal or ilioinguinal lymph node dissection (conventional group, 48; LigaSure™ group, 10) and shared similar characteristics were included in this study. Lymphatic leakage after drain removal was significantly lower in the LigaSure™ group than that in the conventional group (present ratio, 0% vs. 37%; p = 0.02). The daily lymphatic drainage volume also tended to be lower in the LigaSure™ than that in the conventional group, with significant differences on postoperative day 1 (p = 0.02). Other perioperative outcomes including the operating time, intraoperative blood loss, time to drain removal, duration of hospital stay, flap necrosis, and wound infection showed no significant differences between the two groups. The use of the LigaSure™ in inguinal or ilioinguinal lymph node dissection for the treatment of skin cancer could reduce the incidence of postoperative lymphatic leakage after drain removal.