FOR ADDITIONAL PHOTOS AND UPDATES, click the archives at the upper right side of page. My additional blog entries show photos of the graft from 2009 to present.
July 2009 was interesting. I went to the dermatologist, after not doing so for at least 5 years, because I had a brown "age spot" on my cheek that I really didn't like. Just vanity, never thinking it was anything to worry about. Not dark or raised, just a tan spot that had gotten bigger over the years. I was tired of putting makeup on it and trying to hide it. I was 47 at that time.
On that lovely July day, the dermatologist decided she should do a biopsy, and a few days later she told me it was melanoma in situ. She offered to send the slide out for a second opinion, which I definitely wanted, because the treatment was to get this thing cut out and most likely would require a skin graft due to its proximity to my eye. This is when the doctor appointments became numerous, and after being so healthy throughout my life I rarely have to go to doctors.
Second opinion confirmed what the local pathologist had seen. So a date for surgery was set for September 15, 2009 to have a skin graft.
This was stressful, as it would be for anyone. I was searching for information on the internet about this subject and skin grafts on the face. I am younger than most who need to have this done. My skin isn't very wrinkly or loose yet, so there wasn't a lot of extra skin to work with. The surgeon took skin from my collarbone area and put it on my cheek. He also did a biopsy on a brown spot located on my chest the same day just to rule out melanoma there.
I decided to post some pictures here for people who are in a similar situation and might be having trouble finding photos of the whole graft thing. It's all new to me, so I still look at it every day to see how it has changed or possibly healed a little bit more overnight. I intend to continue to post pictures as the appearance of the graft changes. It's now 3.5 months since my surgery and I still hate my graft. It is taking a very long time to heal. As instructed, I do scar massage every day at least twice a day for 30 minutes or more. I am considering the scar revision surgery in the future, but my plastic surgeon said it can't be done "for a long time." I guess that means a year or so of waiting, but hopefully not that long.
|A few hours after surgery|
The entire process was somewhat interesting in a scientific way, if I could remove my emotions from it (but couldn't really). My new appearance caused me to feel vulnerable and unattractive, and I wanted to hide it. The yellow pressure bandage had to stay on for ten days. I didn't go anywhere for those first ten days. There wasn't any pain, but definitely some swelling and a bit of a "black eye."
I had absolutely no idea what to expect. The medical people didn't really explain what was going on with the skin. I was told not to exert myself or sweat, and definitely don't get the graft wet yet. So my husband washed my hair when needed as I leaned my head way back over the bathtub. Good thing I'm flexible!
Around September 23, the sutures were removed from my neck and chest. They removed the hard yellow thing (pressure bandage) that was constantly in the way of my vision, but couldn't take out those sutures yet from the grafted skin until a couple days later. They used surgical tape for the places where the sutures were removed, just to hold it together a few more days. Those places were looking pretty good. Face was still awful to see, and I still hated it. I was glad to hear that the pathology report showed clear margins and all the cells appeared to have been removed. The doctor patted me on the back and said "You won't have to worry about that any more." Well...I guess not, but the scar left behind is a bit of a challenge at times. Seeing that in the mirror when I look up can be startling. Occasionally a whimper would just come over me...I couldn't believe that was going to be part of my face for ever more.
From what I gathered, most grafts heal a bit better than mine and don't always have the black areas of necrotic tissue. Nurse said to leave it alone and it would eventually come off like a scab. Hmmm. She also told me that grafts on this particlar part of the cheek don't do as well. Lucky me (heavy sigh). I was feeling a bit sorry for myself during this phase.
At this point it looked like there was a piece of pepperoni stuck on my cheek. Like, oops, I mistakenly left a piece of pepperoni there! It looked so terribly large, so much skin removed from the area just because of that dumb brown spot. And the brown spot they removed wasn't even THAT ominous looking.
So, I kept putting the bacitracin on it (as instructed) and I was able to take a shower by this time if I remember correctly. I was so nervous about letting water run down over it. I didn't know how delicate it was, or if I'd feel a sting. But as I trembled that day and worked up my nerve to let the water touch it, there was no feeling, no sting. Just felt good to get clean. Had to continue to be so careful about the area for a while though. Couldn't bend over or it would throb as blood rushed to my head.
Sutures were removed...
|I REALLY WASN'T KIDDING ABOUT THAT PEPPERONI, Sept 27|
|Still red and ridged|
October 9, 2009
|Note the other cheek has a couple freckles|
|First attempt at makeup to cover it up|
Makeup just looked plain silly at this point. The scar was was too raised. It will always need lots of moisture and SUNSCREEN. Can't emphasize that enough how to use sunscreen on the graft. My dermatologist told me how quickly this grafted skin will burn (a few minutes). It was already red enough!
Well, it was time for a follow-up visit to the dermatologist in late October. I'd never had a full body screening, so it was about time. She took several photos and measured various freckles. She biopsied the left cheek, a very small freckle in photo above. Found out November 3 that it too consisted of atypical cells and she called it melanoma in situ as well. I am certain that I had blistering sunburns on my cheeks in my younger years, so I don't doubt it. But I just couldn't believe this. Why on my face? I wouldn't mind surgery on any other part of me--but why my face!? It was upsetting. I asked the dermatologist if I could wait a while and she said "she never sleeps on melanoma." Scary things to hear from your doctor.
This is not the invasive type of melanoma, just the precursor to skin cancer, called melanoma in situ. Cells that are on the surface and could eventually become skin cancer.
found out this needs to be cut out too
|November 3, 2009 where biopsy was just performed|
Fortunately, the procedure on the left cheek was much simpler. It was done in the surgeon's office chair, not an operating room like the graft in September. Phew! Just some local anesthetic and I was ready to go within a half hour.
|Left cheek November 10|
|November 12, 2009|
I was feeling a bit butchered by this time. Scar face. Yuck. Still hated the graft side. Was feeling hopeful about how the left cheek would heal since it was a much smaller incision.
I was very happy when I was able to wear a Halloween mask to go trick-or-treating with my daughter. It was so much easier to be out in public with the scars hidden behind a mask.
Scar progress November 18, 2009
I was very pleased with the left cheek. But he said the results showed that some cells went to one of the margins and it may need to be re-excised in a month or so after the scar softened. When would this ever end???
I headed back to the plastic surgeon's office December 14th, fully expecting to have the left cheek re-excised but upon re-reading the pathology report, he didn't feel that it was absolutely necessary (yet). There was no pigment left at the site, so he would just be guessing about where to cut. He said if we monitored it closely, it would be alright, if I wanted, to leave it alone for now. He also offered to re-excise it, but I chose not to. I'd been cut enough. I am willing to keep an eye on it and let it heal. He did such a nice job on that side. I am dealing enough with the putty-looking glob on my right cheek right now. And after all, Christmas was fast approaching. So that was a nice Christmas gift. I felt relieved as I drove home that day. I also wanted to know more about skin pathology and I'm on a new quest to learn as much as I can about atypical cells and melanocytes. What exactly constitutes "melanoma in situ". Sometimes I wonder....this spot had the potential to become skin cancer, but wasn't really cancer yet?
|December 14, 2009|
When I wear makeup, I look like there's a piece of gum stuck on my cheek now. I guess that's better than pepperoni. It's not quite as red, but still very discolored. I am willing to go to the store or a restaurant without wearing my sunglasses to hide it, but people who don't know about the surgery do sometimes look at it and try to figure out what's on my cheek. I feel the need to explain it sometimes to put them at ease. Or is it to put myself at ease? I don't know.
The graft does contract and heal. It's gradually getting smaller. I definitely have to stay with the massaging to try to keep it soft. I can see it changing from week to week. I always wear sunscreen on it, actually all over my face now. Dermatologist recommended Neutrogena with Helioplex, and I use 70 SPF. Plus a hat on cloudless sunny days.
I will continue to take photos of the progression of healing. Skin heals in a fascinating way. And I may eventually get the scar revision done, which is a series of small sections of the graft removed over many different visits to the surgeon's office until it becomes a smaller scar. But it will always be a scar there. A reminder of the cancer that could've been. If melanoma gets into one's bloodstream, that's a bad thing. I don't feel like I was dealing with cancer, but the potential for cancer.
Of course everyone knows one of skin's enemies is the sun. I finally believe that now after all those years of tanning and sometimes burning. The truth is, though, that I'm going to miss having a sun-kissed glow in the summertime. I always felt healthier-looking after a day in the sun. Life's full of little ironies.
IF YOU ARE INTERESTED IN SEEING ADDITIONAL PHOTOS AND UPDATES, PLEASE GO BACK TO THE TOP OF PAGE AND CLICK LINKS AT UPPER RIGHT. ADDITIONAL BLOG ENTRIES SHOW PHOTOS OF THE GRAFT. Each month listed has a photo update.