Objectives Inguinal lymph nodes involvement as first manifestation of ovarian cancer is a rare event and its prognostic value is not well known.

Methods A retrospective chart review was conducted on ovarian cancer patients treated at the University of Bari, between 2008 and 2020. Pertinent clinical information (age, size, histology, BRCA status, laterality at diagnosis, other distant sites of disease), response to first-line treatment, site of relapse and overall survival were collected for 7 patients.

Results Median age at diagnosis was 64 years (range 40–81), 3 patients had other sites of distant disease at the time of ovarian cancer diagnosis (spleen, liver, bone, lung). Median size of inguinal lymph node was 24 mm (range 14–36 mm), 4 had right inguinal involvement, 2 left and one bilateral nodes. The patients had primary surgery including groin dissection, whereas 5 patients had neoadjuvant chemotherapy with paclitaxel and carboplatin following biopsy or removal of groin nodes and complete inguinal dissection was performed at interval debulking surgery. Six patients had high grade serous ovarian carcinoma and one had high grade ovarian endometrioid histotype. BRCA status was known for five patients, and only one patient was a BRCA2 mutation carrier. 4 patients experienced a relapse at a median of 15 months (range 6–25) and in no case relapse was at the level of the groins. 3 patients died and 4 are alive without evidence of disease. Median survival was 64 months (range 16–151).

Conclusions Groin involvement is rare presenting sign of ovarian cancer and this location carries a good prognosis.