Block dissection of the inguinal lymph nodes is associated with a high incidence of complications, the most frequent of which are related to wound healing. To determine the optimal surgical approach, a review of our experience over the last 10 years was undertaken. Fifty inguinal lymph node dissections are presented. The patients were divided into four groups according to the surgical incision used. The duration of hospital stay and incidence of complications were compared. We conclude that the optimal surgical approach is an elliptical incision removing a 4 cm width of skin over the inguinal nodes. Incisions that did not sacrifice at least a 4 cm width of skin had an inordinately high complication rate and a prolonged hospital stay. Approaches to wound closure, the management of bulky disease and primary lesions in continuity with the groin, and the use of adjunctive measures to reduce morbidity are discussed.