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Looking for feedback on amputation vs. skin grafting

Forums Cutaneous Melanoma Community Looking for feedback on amputation vs. skin grafting

  • Post
    Hello, I am newly diagnosed with acral lentiginous melanoma on the bottom of my foot at the base of the toes. I went in for a consult on WLE and lymph node biopsy and was initially told by the surgical oncologist and plastic surgeon that my toes also have to be amputated. After requesting another consult to get an explanation on the procedures, risks, and probable outcomes for both procedures, they agree to let me choose which option to take. I am now desperately seeking people who have experienced either toe amputations, or a skin graft on the toes and bottom of the foot, and who are willing to share what the pros and cons have been for either procedure.

    I am faced with making this decision in the next couple of days and am torn with the enormity of it, especially when so much is based on unknowns.

    Thanks so much.

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  • Replies
        I want to share with you how I was faced with the very same choices back in September 2016. My amelanotic, nodular acral melanoma was situated on the sole of my right foot right next in between my 4th and 5th digits. My melanoma was deep (at least 2.85mm at initial biopsy). It was also ulcerated although it is not clear to me anymore. My lesion looked like a pyogenic granuloma, hence as a outward looking kind of tumour and it was next to an old plantar wart. Anyway, my surgeon said to me at the time that the tumour board wanted my two toes to come off and this was extremely disturbing to me. There was no clear understanding from them that the amputation would help prevent local recurrences and until the very last minute, I was completely torn apart. And really did not want my toes to come off. On the gurney in the OR, I looked my surgeon in the eyes and finally said: do what you have to do. He replied: no, no, I’m not going against your will, I wont amputate. Finally, the plastic surgeon and him (the melanoma surgeon) took the skin in between my toes and grafted back all they took off from my groin area where they did the SLNB. I have quite a big scar on my right groin. The scar underneath my right foot took forever to heal. My surgeons kept telling me that it would heal in the next weeks to months. It finally stabilized after a year and has remained fairly functional. They cut out a nerve underneath to assess for perineural invasion so there is loss of sensitivity and at times itching/soreness still. And as of today, 3.5 years later, I have not recurred either locally or systematically, according to my latest CT scan early February.
        I have been through what you are going through. It is extremely rough, I know. I personally figured that if I was going to recur, I would do so systematically. And if I did locally, I would have my toes cut then. Maybe I will someday.
        You are very right: so much is unknown with our situation. Acral melanomas are still technically skin melanomas but it’s a real crap shoot how to treat surgically.
        If I may, what is your pathology report like? How deep is it? What kind of presentation? Is it ulcerated? Is it wide spread underneath your sole? I came across a study back in 2016 with different analyses and management of acral melanomas on soles and palms. I will dig it out.
        Try and stay calm although it’s really difficult. I made it so far. And changed a lot of things lifestyle-wise. You can do it too.
        Keep us posted. You can also direct email me if you’d like.
          If you are facing a decision between amputation and skin grafting, it is important to consult with your healthcare provider to discuss the specifics of your situation. In general, amputation may be necessary if there is significant damage to the affected area and it cannot be salvaged with other treatments. However, skin grafting may be a viable option if the damage is less severe and the area can be repaired with new tissue.

          Ultimately, the decision between amputation and skin grafting will depend on factors such as the location and severity of the injury, your overall health, and your personal preferences. It is important to have a clear understanding of the potential risks and benefits of each option before making a decision. Your healthcare provider can provide you with more information and guidance based on your individual needs and circumstances.

            ed williams
              Did you even read the comments and the dates written??? A day late and a dollar short comes to mind!!!
              It sounds like you have recently been diagnosed with acral lentiginous melanoma on the bottom of your foot at the base of your toes. You are now considering two options – either toe amputation or a skin graft on the toes and bottom of the foot. You are seeking advice from people who have had experience with either procedure to help you make an informed decision.
              Anjali Tiwari
                I am not here to give suitable feedback on amputation but I have something that I want to discuss with these discussion forums. In 2019 I suffered from serious issues in an accident, I had a case amputation on my left hand’s small finger, and it is no more with my all finger. The doctor gave me treatment and told me to replace this finger with an artificial or duplicate finger. So, now my question is that if I attach an artificial finger to my amputated part, the figure will move as a natural finger can?

                Do reply if anyone has an idea about it. . .

                  Ive had two skin grafts on the bottom part of my left heel. The first graft was to remove the quarter size acral melanoma and the second to remove a recurrence. The first graft healed well, but the second graft underwent radiation and is slow to heal 3 years later. There is much more to that story, but I would undergo a skin graft first as the option to amputate would still be there if something didnt go right.
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