Question about WLE

Hi Kaussie

I was told that the same amount is taken ALL the way around, ie underneath as well as around the original excision site. Because my melanoma was 1.4mm deep I had a 2cm WLE but my scar, on my arm, is lovely and flat and barely visible.

I think it might depend on the skill of the plastic surgeon and how they are able to do the WLE. In my case, I didn't need a graft because he said there was plenty of skin to be able to pull the wound together. When I saw it it looked really ugly and very raised. However, the nurse explained that the reason it was so raised was because that as it healed it would sink and I would be left with a flat surface whereas if it was sewn flat then as it healed it would sink and form a crater.

x

Hi. Thanks for the info. I’ve been told by the surgeon they will try and pull it together it’ll be very tight  but I may need a graft.  it’s on my lower leg. I’m hoping it can be pulled together as they said grafts don’t always take.  I’m dreading it but want it over if that makes sense. I keep thinking it’s gonna take about 30 mins ish. I can be brave enough for that time and I was ok having the biopsy.  Hope you’re keeping well. K x 

Hi Kaussie

I can relate to the wanting to get it over and done with while dreading it at the same time. I had a general anaesthetic, as I was also having a SLNB at the same time, so I don't know how long the WLE took.

I'm fine, thanks for asking. Had a skin check a few weeks ago and everything is currently good.

x

Hi latchbrook. That’s great news for your recent check up  my nurse told me the op should take abut 30-40 mins and I’ve got to isolate for 5 days before. I’ll be doing plenty of housework that week to keep my mind occupied lol  K x 

I can think of nicer things to do than housework

Hi,

i had my wle with skin graft just under two weeks ago in my ankle. I didn’t actually look at the time of the operation but I went back last Tuesday for the dressings to be changed for the first time and was quite shocked at how deep it looked. It looked like a crater in my ankle but the nurse said that’s quite normal, that as the area heals the area will puff back out and look flat with the rest of the skin. My melanoma was originally 0.7mm deep and they took a 1cm margin all around d the original biopsy area and it was full skin thickness. I hope that helps a little. 

Hi Kaussie, 

My melanoma was 1. 1 mm on Breslow scale (stage and WLE removed further 2 cm around it. Mine was on my tight just above the knee and didn't need a graft, scar healing well. Nice guideline says:

"Offer excision with a clinical margin of at least 1 cm to people with stage I melanoma.Offer excision with a clinical margin of at least 2 cm to people with stage II melanoma."

Hey Elmyra. Ah ok, I wasn’t sure what it all meant,  I presumed they were taking 1cm round my scar but wasn’t sure if it was also a cm deep.  I really need to ask more questions when I go to my appointments.  Wish the op was over and done with. I’m not good at waiting. Glad to hear you’re doing well and healing nicely K x 

Morning Kaussie,

I can completely understand the uncertainty around going in for your WLE. It's a new experience for you, over which you have no control.  The only experience you have to measure against is your previous op. And even having a good experience for that as I did, I was extremely anxious and scared of the unknown, of being cut, of not knowing how I would recover or what I would be able to do afterwards, of knowing I would have to wait for results again ...

It was explained to me much as Elmyra has explained - 1cm from all sides, including depth. But, I was told that this is 1cm from the depth of the mole, not the depth of the previous excision and that the surgeon takes this into account.  Whether some of this is specific to 1A and the fact that mine was all caught in the previous extraction so the WLE was precautionary, I have no idea.

My scar is long, longer than I expected, but it is neat. My operation was about 45 mins on the table. It was an hour for removal of 4 moles previously so it shows the level of concentration and skill that went into ensuring it was sewn up effectively.  This was the longest part, the sewing.  A good team, knowing you are worried, should distract and chat to you.  (I learnt of a great sewing site from my surgeon and have already made a pair of pyjamas in the week I've been recovering so far!)  I quizzed them throughout the surgery about what I could and couldn't do (after she told me 2 weeks with my leg up) - no supermarket shopping, no walk to the PO box but I can drive to get my booster, haha!  Those were my questions, along with aftercare (stitch removal, strapping for 3/4 months, Vaseline etc.).  While I had their undivided attention, I asked ALL of the practical questions that were running around my head - good distraction as well.

While I had some pain during the surgery this time, which I told them about (or rather flinched) and they gave more anaesthetic, my pain level afterwards has been significantly reduced.  I don't know if that's because there are 2 layers of stitches holding me together this time, I'm used to it having wounds now or it's just one wound rather than 4.  The bruising is coming out now and that achy pain is what I currently have, which is the worst it's been (touch wood) - and, I should probably be resting more with my leg up (as instructed) more than I have been! 

Paracetamol taken during the period when anaesthetic wore off made a HUGE difference and I would recommend that to anyone.  Last time, I woke in the middle of the night from the pain of the nerves realising they were severed - 1 wound after the other in the order they were put under. Not fun.  This time, I had taken paracetamol but I was still waiting for a sign of it - but, nothing.  I also had a compression bandage for 48 hours this time, which given I had 4 last time wasn't possible.  I found this helped me as well.

I would suggest telling your team that you're nervous and about what bit - so they can talk you through it and it doesn't feel like it's happening 'to' you and so you feel reassured.  

Apologies, I've ended up waffling ... I hope it all goes well for you. xx

Hi KKat23. Thank you so much for your reply, you’ve not waffled one bit, in fact it’s been a reassurance really. I don’t really know what I’m nervous of, I’m trying to think I got through the biopsy ok and hoping this will be the same if not a tad longer in time. I think it’s the unknown really, I wasn’t too keen on the sensation you get with a local anaesthetic but I had no pain as such when I had the biopsy.  I will be like you asking lots of questions when I’m on the table and generally doing everything possible to distract myself. I’m sorry to hear you had pain in the operation but at least they gave you more anaesthetic. I was told by the nurse I’ll need to keep my leg elevated for a week or two and I’ll probably be off work around 3-4 weeks. She also said with me being stage 1A it’s a belt and braces procedure and that she fully expects my next results to come back clear. That put my mind at rest slightly.  Thank you again and I hope you’re ok. Good job it’s Christmas to keep my mind occupied. xx