What is Skin Cancer
In medicine (dermatology), there are several different types of cancer referred to under the general label of skin cancer.Skin cancer is a malignant growth on the skin, which can h...
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What to do - skin graft or not
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Hopefully you guys can help me think this thing totally through. I went for my 50 mole check (at 52) and showed the derm a freckle on my ankle that I've always had, but it had a tiny dark spot in the freckle. He look it over and immediately said I needed a biopsy. He did it then. The next week I was notified it was a melanoma in situ and I needed to see a derm surgeon. One office made the appointment with the other office. When verifying the appointment I ask if any procedures would take place at the first appointment I was told no - we would discuss treatments. I was fine with that.
I arrived at the surgical derm office, filled out paper work and then went back to meet him. He went over the pathology, what exactly this meant, damage, etc. Any and everything, I was totally pleased with his explanation. The he said "I'm going to do this now." I couldn't believe it - at least I didn't have time to worry! I felt totally confident in the referral and this doc so he did surgery then. He then put me in a soft cast totally around my leg to protect this area. I was told we would change the cast weekly (Obviously keeping it totally dry,clean, etc) and would make certain all margins were clean with more pathology Thankfully the margins were clear so the next week he changed the cast. I wasn't prepared for the wound. No darned wonder this thing had hurt so much. It is 2 1/2 x 2 1/2 - pretty big size on an ankle. Which brings me to the question (and sorry for the long explanation) at hand. The doctor has proposed a skin graft. Using skin from my inside upper arm to the ankle. I listened and assumed it was a done deal. When the doc left the room the nurse said I didn't have to do that - that skin graft sites are extremely painful, etc. Said this would in a long time heal on its own, but to consider not doing it. This week when he was changing the cast he asked if I'd decided - and said he knew the graft site would be painful but letting this heal on its on may prove to be problematic itself. He certainly isn't pressuring me on way or another. He nurse again said to think about the graft site and how sore it would be. There you have it, sorry its so long. Seems I'm decision in parred with this. I will have at least two more casts before he'll do the graft, if I choose that - meaning the first of Nov. This thing hurts like *&#*, that I've been very surprised about, and I'm usually pretty tough bird. So gang, looking for information and decision help here. Any idea's? Posted on 10/21/09, 02:10 pm |
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I hope you are doing better. From my experience, I would get a second opinion from another doctor. When I had basal cell cancer on my nose, the nurses said it was very small, not to worry, no one will notice, etc. Well, it was as big as a dime, I had to have bilobe flap reconstrution to repair the wound, and I'm still headed for one more cosmetic repair surgery. Three surgeries total. I know the nurses were trying to be helpful, but I wasn't prepared to face the facts in the long term. When I went back to my doctor after MOHS, he suggested doing some cosmetic surgery repairs to correct the deformity left by the MOHS surgery. Before I made a decision on what to do, I asked him to refer me to the department head for a second opinion. I am so glad I got the second opinion. I now have the department head doctor, who is one of the best in Northern California, as my surgeon. I wish I had him in the beginning. Good luck to you! 
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I would get a second opinion also. Also, I would make sure I have any other diagnostic tests they suggest. My girlfriend had a melanoma and she had to have endoscopy, plus colonosopy after the diagnosis. I am so glad that you had it removed quickly. Take care and God Bless, MaryAnne
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Thanks for your comments. I've totally confident in the doctor - its the decision about a skin graft that has me confused. At this point I'm almost thinking I should have the graft because I'm scared of the long term means of totally keeping an infection out of this while it heals. Also I do not know, nor have I asked, exactly how a scar of this size will look - meaning color, texture, etc. Gad, so many questions.....................................
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Hi, KansasSun.
Can be overwhelming, can't it?!? And it's like those commercials "tell your doctor what medicines you are taking..." Um...isn't my DOCTOR supposed to know? But anyway, I've certainly become a more informed consumer about skin grafts than I planned to be. First of all, there are a variety of ways that large wounds can heal. One is called granulation -- which is just simply letting the thing heal on its own. Takes a while, scars, there is the concern for infection, but there's only the one wound. Then there are flap repairs (moving adjacent skin over...not appropriate in all cases) and grafting, either split-thickness or full-thickness. A split-thickness graft takes just the topmost layers of skin from your donor site, which then is compared to recovering from a burn -- thin skin, which needs time to regrow. A full thickness graft takes all the thickness of the skin needed to repair, and the donor site is often stitched closed. Me? I had a basal cell tumor removed from my face this past August, right under my eye. Was left with a wound about 2 inches at its widest, which was repaired with a full-thickness skin graft. The donor skin was from the back of my ear. Painwise, it wasn't horrendous, and the donor site annoyed me more than the grafted site. (Considering the fact that my surgeon would only allow Tylenol...and I did okay, then you could say it wasn't horribly painful.) There are scars from the surgeries, which I do my best to cover with makeup (sounds like yours might be coverable by socks and pants), but it healed fairly quickly. I was off work for 2 weeks, then back into the fray (mostly because it was so near my eye, and they wanted me pretty still while it healed). Find out if they're thinking full thickness or partial thichness graft...that can help in your decision. From what I've learned, partial-thickness donor sites do indeed feel like a burn, and full-thickness have the discomfort of an incision and tight skin (since they took the "extra" and stitched that site tight. Good luck with your decisions and research, and let us know how the healing goes, whatever you decide. I am so glad to hear that the margins were clear after your surgery! Do good follow-up care!
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I'm off to the doctor today to have my soft cast changed and will get to look at this thing again. I'm going to ask more questions - they are quite patient with me.
One minute I'm doing a skin graft and the next letting it heal on its own. I guess what hasn't been discussed is an approximation of how long this will take on its own. I'll report / ramble about my appointment shortly!
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Back from the doctor. They changed the cast dressing and frankly there is noticeable healing from last week. Now not much, probably the width of the end of an ink pen, but you can see it. They want me to do "wound" care until the next doctor visit. On Wed and Fri I'm to take the dressing off and shower - then redress it. However, I've pretty nervous because I was told it "won't be a pleasant experience, it will hurt." I can only imagine. To dress it I'm to use Vaseline and fill in the indentation - then this non-stick pad then 7 large pads then wrap the entire ankle.
In discussing skin graft vs no skin graft the nurse did admit I'm border line either way - tough call. The thing is she says that the end result will look the same. Is that true - said I'll always have a whiteish circle patch look at the wound site.
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Good luck!!! I hope you heal fat whetever you decide. I am glad they got the Melanoma out quickly. take care, MaryAnne
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Thanks for the support guys. I'm still undecided about the skin graft. Wound care isn't too fun, but there are certainly much worse things to deal with - its all in the prospective.
I will say that I am letting others (friends) have an opinion where I need to step up to the plate and handle this decision. I'm more leaning towards not doing the graft - however, doing it has some valid points. I'm thinking I'll try to deeply discuss this with the doc and go with his decision - after all its his area of expertise, not mine. I'm mentally going to go thinking I'll have a surgery and if I do great, if not that's great too. What do you all think? Is that an ok attitude? Who knows!
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I don't know if my experience will help but I had a very large squarmous cell tumor on my left pointer finger. I had an excellent surgeon and he told me up front that I needed a skin graft. He did it the same day he operated on my finger. It was a deep tissue graft taken from the underside of my arm. The only part that hurt was the needles to freeze it. He packed tissue in the hole in my finger, about the size of a quarter and timed the overlay of skin graft several times to get it just right. The graft did not hurt me however before all the stitches were taken out there was some stinging. The stinging was minor though. My surgery was about a year ago and I have done well with it. I'm scared but that's OK. It healed well.
Now here's another story. My motherinlaw had a melanoma cancer removed about two weeks ago on her leg. She did not have a skin graft. The hole which is about the size of what you discribe on your ankle is filling in. I don't know how but it is getting smaller and isnot as deep as it was. Her dressing is changed daily. She is walking around and doing well. Perhaps an ankle takes longer to heal and may hurt more than my surgery or my motherinlaws. I think that if you have any reservation about what to do you should consult with another Dr. This may make you feel more comfortable with what ever your decision is.
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Thanks for your input. Glad your doing well and is your mother in law. My ankle wound (we've nicknamed it the beast!) is very slowly granulating. It looks so very bad - blood red and purple. The doc said it would heal and be light colored white - this is no where near white! Of course worring I thought tonight what if I do all of this for months on end then end up doing the graft because of how horrid it looks! Hopefully that won't happen though.
I will say everyone should take stock out in the products I'm using because this wound care is costing a small fortune. I see doc on Tues - we'll see what he has to say then.
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