Wide local excision- or not

Hi Lizzie

So sorry to hear of your diagnosis. I recently had to make the same decision and it looks like our cases are quite similar at face value. Mine was on my left shin a couple of inches above my ankle. It was 1mm depth which originally I was told was 1a but the surgeon later told me was 1b based on the depth of 1.0 mm. He told me there was no ulceration, no satellite nodes 0 mitosis, no obvious issues with my lymph nodes and no otherwise concerning features. The WLE and SLNB were optional. But his view was he recommended I have them for 2 reasons. Better certainty, and earlier treatment if progression was detected. He felt that progression is unlikely, but he couldnt guarantee it. 

For me the decision came down to a few things. First I already beat myself up on how long I left it to go to the doctor originally. I also have young children which factored into it too. And I’ve had quite a few brushes in the last few years with cancer through friends and family. On balance, I decided to have them and am currently awaiting the results. I am a worrier and I wanted the clarity and certainty it would bring, even if it is bad news. I also wanted to be able to tell the kids I did all I could if things don’t go to plan. 

I’m sure having the WLE and SLNB isn’t right for everyone, but I don’t regret having them myself. I had to have a skin graft and the WLE is much bigger than I expected (I was told 1cm margins required too). When all is said and done it is a very personal decision, but I do wish you the best, whichever path you choose.

Thank you for your reply. I think it is having to have a skin graft that worries me. How did you find the recovery after the graft? 

Recovery has been better than I expected considering I’ve never had an op before. I had mild discomfort the first few days, after that all of the wounds were only sore if I overdid it. First 2 weeks while I could get up and about to go to the loo etc, they wanted me immobile and leg elevated as much as possible and wear a surgical stocking on the leg that was not operated on. I’m nearly at week 4 and the wound still looks and feels very vulnerable. They told me it will likely take about 12 weeks for it to heal to 80+%. But I can walk on it and last 5 days or so I can drive but it can get a bit uncomfortable - nothing too bad though. The WLE itself is a 2 to 2.5 inch diameter circular hole and about 1.5 cm deep Id guess.

The donor location for the graft on my thigh has been fine aside from when they removed the dressing at 14 days as it was well stuck solid to my skin. The slnb ive not really noticed at all except for when I touch it and a bit of tightness/ dull ache down my thigh and back of leg down to my knee. The op itself was very smooth. In at 7am , went down to surgery at 9am and I remember waking up in recovery at about 11 and then home by about 3.

Hi Lizzie

Sorry to hear about your diagnosis. I had a WLE and skin graft on my shin just above my ankle 10 days ago, I think my situation is also similar to idg559, but I'm a few weeks behind.  I have stage 1b melanoma as the depth is 1.2mm and like you I questioned whether it was necessary to have a WLE as I did not want a skin graft and the scar that the WLE will leave.  For a number of different reasons, I decided to go ahead with it and am currently recovering from the surgery and awaiting the results.  It's a hugely personal decision that has to be right for you and your circumstances. I am aware of someone on a different forum who didn't have a WLE who subsequently went on to have further problems years later, however there may be many people who haven't had reoccurrences, but they are probably less likely to post on one of the forums. I wish you all the best with your decision and whatever treatment you have.  

Thank you very much, that has helped me with my decision. I think I will have the WLE and skin graft. I guess it is a case of short term pain for long term gain.

Best wishes for your continued recovery. 

Good luck and best wishes with it all to you too Lizzie. Eli_7 I hope your recovery is going ok also. Im actually only about 2 weeks ahead of you. Its interesting there's a few of us here with very similar cases at the same time at the moment. 

Thank you both. I have an appointment with the plastic surgeon on Monday to discuss the surgery. I think my decision was also eventually made easier as my practice nurse said it was unlikely my current wound would heal well without a skin graft.  So decision made. 
Best wishes all. 

Hi Lizzie2023, I was just wondering how you’re getting on now two years on? My situation is similar where the melanoma I had was 1.0mm deep and I’ve recently had the WLE, just waiting on the results.