Wide Local Excision

NickM · New User Joined: 02 Aug 2009 Posts: 1

My wife probs has a malignant melanoma. She is awaiting the full biopsy results and may need plastic surgery (she's had an excision biopsy). Any of you good folks got any links to what this will actually be like and what the cosmetic result is likely to be.

I hope this doesn't sound shallow (the cosmetic stuff) but she's a very attractive thirty year old woman and proud of her appearance and it's not me I'm worried about because she has a previous history of deliberate self-harm and bulimia and has only just in the last few years got comfortable in her own skin.

Moreover, I appreciate I probs shouldn't ask before we get the biopsy results but I'm a "looker ahead" and I like to know the possibilities.

I've found lots of stuff on the web about survival rates and Breslow staging and all that but what I'm interested in is experiences of the surgery and healing times (another factor here is that she's self-employed) and what the end result might look like if they have to do a wide local excision and skin graft.

The excision was from her right shoulder. How long would a skin graft affect mobility for example? My wife is a translator so she basically types for a living. She is though left-handed.

Also does the patient have any choice in the location of the donor site? 'cos she's particularly proud of her ass and you know she does her translation sitting down as well.

I hope these questions don't seem trivial. They certainly aren't to me right now.

Nick

Manchester, England.

reneevan · New User Joined: 02 Aug 2009 Posts: 2

Nick,
Please don't feel that your concerns are trivial or shallow. I too am worried about how much tissue they'll take, how big of a scar, etc. Our bodies are a constant reminder of our health and well being, and as for me, I don't want any reminders that I am broken. My wle will be in a place I can easily hide, but I have to say I am a little concerned if my husband will find it gross. The other wle will be on my leg and out there for everyone to see... will I constantly have to explain cancer? I hope for a small easily hidable scar to avoid that! That being said, there are some wonderful products to camoflage scars now.
Blessings, Renee

brainman · Posted: Sun Aug 02, 2009 12:26 pm Post subject: Re: Wide Local Excision

Hi Nick. I am very sorry about your wife's cancer. I really do not have much info about recovery time and such. My only knowledge about skin grafts was with burn victims... a whole different set of issues involved there.

I do know that most of your concerns have to do with the size of the area and the skill level of the plastic surgeon. In England you may not have a choice, however, if you do, get the best surgeon you can.

As for having input in the decision about the donor site, yes. She can at least be a part of that discussion. However, the skin graft they use is no thicker than a sun burn and should not be a cosmetic problem.

You and your wife are in my thoughts and prayers.
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HaoleBoy · Senior User Joined: 19 Aug 2008 Posts: 108

Nick, the surgical margins for the WLE depends on the thickness of the tumor.... The following margins are protocol in the United States at the major cancer treatment centers (National Cancer Institute designated facilities.... haven't a clue what they are in the UK)...

Melanoma in situ is a 5mm radius of skin excised.

Melanoma 1 mm and thinner is 1 centimeter radius of skin excised.

Melanoma 1 mm - 4mm (intermediate thickness), standard is a 2 centimeter radius of skin excised.

In all cases, they cut down to the muscle fascia....

The scarring is of course dependent on the tumor's thickness, but most people who have a WLE do in fact have a prominent scar...

I will guess that the donor skin will come from either her hip area or the front of the thigh.... In my case, they just amputated a toe and I didn't have a skin graft -- left the wound in the front part of my foot open for normal granulation....

I understand that women, much moreson than men, always have cosmetic concerns.... but the real focus needs to be on gettng this life-threatening cancer out of her body, if in fact it is melanoma, and on her follow-up care....

Haole Boy
Stage IIA
Hawaii (Oahu)

bigolly5683 · New User Joined: 19 Aug 2009 Posts: 1

Please do not jump to conclusions and do not call it cancer until the biopsy results are back. I had a WLE done on the inside of my calf apx 10 years ago. If you look at the papers from the initial visit to the dematologist office, there is a box marked that says "malignant melanoma." However, I went in to have the WLE done and the results came back that it was not malignant. Therefore, I would not call it cancer. It was a fast growing, protruding, multi colored, ugly mole about the size of a quarter or just smaller when they removed it. I can see an indent on the inside of my calf if I turn my leg the right way. The scar is about 3 inches long. Do I know its there? Of course. Honestly, yes, it's less visible that a scar on the shoulder will be. But millions of ppl out there have visible scars. It's not on her face. I had several stitches on my face, done both inside and on the outside, to put it back together after a car accident. A plastic surgeon did it and some cant even notice the scars unless I point them out. I know they are there. Your wife will know its there, but seriously, nobody is looking or judging.

But again, do not call it cancer until the biopsy comes back positive.....unless someone that went thru the same can tell me different. I dont remember all of the details of my surgery, but havent had any issues since.

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