Melanoma treatment options

I just noticed a big typo in my original post . My melanoma was Stage 1 not 2, Thank goodness.

@barbjo, well that is a good typo. I'm glad to hear that your melanoma is stage 1 not stage 2. I'm bringing in @jenniferhunter and @gingerw into this discussion as I believe they may have experience or knowledge to share about elliptical incision vs open incision.

I'm glad to hear your incision is healing nicely. But I sense that the change in surgical plans left you feeling unsure or questioning. If you have any concerns about the healing process, don't hesitate to contact your surgeon's office for an earlier appointment.

You are good at your job! I do think better pre and post surgery information would of helped. I would really like to talk with other that could tell me their experiences.

@colleenyoung You're right! Stage 1 instead of Stage 2 is a good typo to make/have.

@barbjo I am glad to hear the area is healing well for you. In my experience, although a doctor may have an initial plan for details of a surgery of any kind, they need to remain flexible and be aware that plan might be modified somewhat. It sounds like what happened here, except you were not fully informed, perhaps. A review of the surgery site on day of surgery brought a change in plans.

An elliptical incision typically is done to minimize a resulting scar and align with the normal skin creases. If the area has little fat or loose skin, it can be mighty uncomfortable as it heals, and the particular location may be prone to pulling on the incision if stitches are used. Not knowing how large the area is that you had excised, that might have been the case, and an open incision would heal cleaner. In my situation, they did a flap incision, pulling over the skin on my forearm. That hurt like the dickens healing, as the skin was stretched out over the 32 stitch horseshoe shaped scar! A recent squamous cell surgery was done as an open incision, in my eyebrow, because it was small and stitches would have pulled the surrounding tissues.

Check with your doctor to ask what the best method to address the scar will be, perhaps a good Vitamin E cream. And, wear sunscreen!
Ginger

@barbjo I can understand how you are in some uncharted territory wondering what your skin will look like after the surgical site has healed. Your surgeon probably made a better choice, not doing stitches if she thought it would pull when you walked. That would be painful and would yank on a wound that is trying to heal. The experience I can relate to you is from breaking my ankle badly that resulted in 3 surgeries. The first placed a large metal cage outside of my ankle and it was screwed directly into the shin and heel bones to stabilize it. That allowed the swelling to subside a bit before surgery to fix the ankle in place with surgical hardware in the 2nd surgery. The 3rd surgery was to remove the hardware because it bothered me.

During the time after the 2nd surgery, I was in a cast with stitches on both sides of my ankle with about a 4 inch incision on one side and the other was less than an inch. Even though I wasn't walking or weight bearing, the stitches would catch in the gauze wrap inside the cast and pull on them which hurt. I was miserable, but had to endure that for 6 weeks. The wounds from the external cage were open deep pits and had some necrotic tissue that was later debrided in the 2nd surgery, and the larger one formed a scab and multiple layers of skin under it. The scab didn't fall off until a couple months after the cast was removed, and then it continued forming scabs and shedding layers for several months. It started as a very raised bump than was reddish. The top layers would start looking white as they separated from the stack and would rub off. It really took about 9 months until the scar and the rest of the area leveled out. Healing on the lower leg also takes a lot longer than on the rest of the body.

My husband also had melanoma removed from the side of his hand on the pinky finger side, and his was stage 2a that had broken through the skin from underneath. It was the size of an eraser on a pencil, and looked like that too because it was the same color. They took a wide excision around it, and that required a skin graft sutured in place from a plastic surgeon during the procedure. The skin graft came from the groin area, and it was red during healing and was a bit infected, and antibiotics cured that. Because all the skin and underlying tissues were removed down to the muscle and bone, the end result is that it is a sunken area on his hand of lighter colored skin graft. The "seam" at the edges are a bit raised and painful because of nerve damage from what was removed and he has numbness in part of his hand and half of the pinky finger.

One other thing I would mention is that during healing and for the first year, if you protect the wound/scar from sun exposure completely, the scar will be lighter in color. I am also a spine surgery patient with a scar on the front of my neck that was placed in a neck fold to disguise it. It is lighter than my skin and tightly closed and people never see it. I wore a neck bandana all the time if I was outside that first year. If a healing scar gets sun exposure, it forms more pigmentation and results in a darker colored scar that is usually darker than the skin around it. Protecting it from sun exposure prevents this from happening.

Thank you so much! I think part of reason is I went home with a sheet for after care that had was for an incision with sutures. My next appointment said “suture removal “. I made some phone calls but didn’t get the correct information on proper dressing changing until my wound check two week appointment ( previously called suture removal). I saw a nurse that had great tips that helped my comfort and briefly mentioned circulation . I feel I was well prepared to fight infection, but not told my about circulation and nothing about it taking longer to heal because of the location. I’m pretty sure I was told 3 weeks. Today after 5 weeks , I find out this is normal that is going to take longer. I’m sorry you and your husband have gone through so much. I blew out the ligaments in my ankle once . Months in a boot, but nothing like yours. The pain walking lasted a long time though. Walking isn’t painful with this , the circulation issues and fatigue have been . But that is getting better.
I can’t tell how much I appreciate you taking your time to share this with me. Some of my family has questioned my long recovery . So I’m glad I decided to join this group.

I’m feeling pretty lucky right now, because the incision itself hasn’t been too painful. I think the shock of seeing a hole the size of the bottom of a water bottle and deep too was tough. That was four days after surgery and five weeks later I’m feeling more optimistic. Thanks for reminding me about looking into scar cream. And sunscreen and more clothing are definitely a life long plan. From the location on the lower leg, I think I had the right incision now. I so appreciate you sharing with me.

@barbjo Thanks for your information. I am having trouble with ligaments and tendons hurting. How long did it take until your ligaments were recovered and not hurting anymore? Years?

Some of this is extreme fatigue when I have walked too much with my current limited strength. I take care of horses outside and have to walk on uneven ground or even through mud sometimes, and that just kills my ankle when I have to work to stabilize it. I have been wearing an ankle brace and using custom orthotics inside of a work boot with toe protection. I got a medical boot too after the cast was removed, but I couldn't stand to wear it because of the weight of it hanging on my injured ankle caused so much pain. Recently, when my ankle was bad, I did put it on a couple times to immobilize my ankle so I could walk around feeding horses. My fracture was 2 years ago.

Just recently, my physical therapist showed me how to mobilize my ankle because the joint gets stiff and the talus can come forward and get stuck. Then I get a pinch and sharp pain in front and my ankle gives out under me from the pain. I lost some cartilage in my injury, so my joint space is a bit smaller. I can be just fine walking on firm level ground, and then all of a sudden, I can't walk. I do stop and circle my foot around trying to realign the joint. I also do better if I manipulate my foot around first thing each day. My last surgery to remove hardware was 8 months ago, so I may still be recovering from that. I had muscle atrophy because I could not bear weight for so long and my leg is still smaller than it's neighbor. I don't know how much injury there was to my tendons and ligaments and the surgeon said it would heal itself, but it was a fracture, a dislocation, and a sprain all at once in what they call a bimalleolar fracture. Basically that means you break both of the "knobs" off each side of your ankle and I had some puzzle pieces on the front of the tibia. It was compound with the fibula breaking through the skin. I could feel a nerve throbbing right after it happened and I straightened my ankle just enough to take that pressure off, but not fully straight. That may have saved me from some further nerve damage because it was close to 3 hours after the injury that I was going into surgery. It is a very long recovery, and maybe full maximum recovery won't be for 5 years? I just don't know, but I'm doing the best I can. If I do too many exercises to try to rebuild strength, I just bring on the fatigue and pain, then I can't walk, then I hobble around holding my foot like it is in a cast to try to prevent moving the joint.

I'm glad you joined Connect too. I really enjoy it.

It gradually got better in about year. My daughter in law is a physical therapist, so I did simple exercises at home, One other thing was when I started to sleep with the boot,it helped . It was my left leg so I wasn’t straining it driving. That is a real problem for me now. I like to be on the go, and driving pulls on my incision.My ankle was only ligament which made it easier. The boot felt good once the swelling went down. I’m so sorry this has drug on so long.

@barbjo Well, I went for the bonus driving difficulties by breaking my right ankle. It gets tired driving, and then I remember to use the cruse control. That doesn't work well in stop and go traffic, but is fine on the highways. I usually sleep with my injured ankle immersed in several pillows to protect it from my cats. One in particular likes to sleep against my lower leg. That lets me slide my leg out from under a pillow (with a cat on it) and gently change position with out my foot being attacked under the covers as cats love to do. I could try the boot at night and see if that is better or if it is more difficult to move around.

I think your driving incision pain will get better quicker in less time than the ligaments healed. I have a lot a patience which you need for a long recovery and a great physical therapist too. It's probably for the best that you don't have stitches adding to the misery.