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Advice for plastic surgery for WLE / acral melanoma

Mazza
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  • 44 subscribers
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Hello,
I've been diagnosed with stage 1B acral melanoma and am going to have WLE and SLNB next month.
The WLE is under my little toe, which is a tricky spot. For the original surgery, they did a skin graft which hasn’t taken so it’s healing but very slowly.
For my WLE, the plastic surgeon gave me two options I need to choose from for the surgery day:
  • Option 1: removing the bone in my little toe and using the skin of the little toe as a skin flap - this means I will technically lose my little toe (was told it will heal better)
  • Option 2: doing another skin graft (maybe taking skin from the plantar fascia?) but healing will probably take longer than the first option and, if the skin graft doesn’t take, the skin could grow in from the edges

I don't know which decision to make: option 1 seems "simpler" with a potential shorter healing period but it means losing a toe and option 2 has risks of the graft not taking, maybe wound infection and the source of the skin graft to heal but I would keep my toe...

What are the usual experiences with skin grafts on feet/under toes? What are the risks of the graft not taking, risks of infection I need to be aware of?

Is it true that healing using a skin flap (option 1) would be much faster than with a skin graft?

Any advice would be helpful so I can make an informed decision. 

Thank you.

  • Hello Mazza,

    Thanks for getting in touch with us. I’m Linda, one of the nurses from our support line. I hope you are finding the forums supportive. 

    It’s understandable that you are finding it difficult to make a treatment decision. It may be useful to have a look at our information above.

    It’s good that the plastic surgeon has explained the options to you. It’s never easy to choose but it may help to write down the pros and cons of each one.  

    Sometimes it does come down to personal preference or a gut feeling.

    The plastic surgeons are the best people to guide you as this is their area of expertise. I would encourage you to talk with them again to clarify the risks of the graft not taking and infection risks.

    Having any type of surgery does come with risks but the team do all they can to minimise them.

    You may wish to have a look at BAPRAS (British Association of Plastic Reconstruction and Aesthetic Surgeons.) They have patient information and booklets that you may find helpful.  

    It’s suggested that skin flaps often heal faster than grafts and the following information from DermNet may help. DermNet also have useful information on skin grafting and the possible risks.

    I hope this helps and that you make the right decision for you.

    Take care and best wishes,

    Linda J.  (Cancer Information Nurse Specialist)

    You can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or send us an email or use webchat.

    Ref: LJ/VG

  • in reply to Linda J - Macmillan

    Thank you for your reply, Linda. I'll have a look at the links you shared. 

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