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Looking for feedback on amputation vs. skin grafting
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.
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.
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