Fourteen Years Later

Age 62

My scar is, of course, still visible under my right eye, but it's part of me now and I hardly ever think about the graft until I see it in photos like this. I'm 62 years old now. I recently had a couple of small areas on my other cheek "frozen" at the dermatologist. I suppose the skin on my cheekbones took the brunt of the sun over the years. 

My husband had a small melanoma on his back which was found early (by me) and removed last winter. They had to cut quite deep and wide to be sure the margins were clear. The annual visits to our dermatologist will continue.

 

Autumn 2017

Eight years later, still enjoying the outdoors and always wearing sunscreen.

Age 55

Spring 2017

A recent photo from April 2017 . . .

Seven Years

2016

Seven years ago during the month of September my graft was my biggest worry. The passage of time has helped the unpleasant memories fade. My face ages and the scar softens gradually with each passing year. I'm grateful for all the supportive comments and input I've received from readers. Thank you.

October 2015 Pictures

Photos taken October 2015

The scar shows more in certain lighting

Six Years Later

I just want to thank everyone who has written to me and shared their experiences over the years. I still read every comment that is posted, and try to reply to all.

This is how the scar is looking now, in 2015, six years after the graft. 

NY Times Article (thank you, Garden Girl)

Excellent article shared by a fellow blogger.

An excerpt:
The specialists point to an epidemic, noting there are two million to four million skin cancers diagnosed in the United States each year, with a huge increase in basal cell carcinomas, the type Ms. Little had, which usually do not metastasize. (A small fraction of the cancers are melanomas, a far more serious condition.) But, said Dr. Cary Gross, a cancer epidemiologist at Yale University Medical School, “The real question is: Is there a true epidemic or is there an epidemic of biopsies and treatments that are not needed? I think the answer is both.”

Full article from 2014 here:

http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html?_r=0

Scar After Five Years

It will always be a scar but I see improvement every year.

Folks, Get Your Second or Third Opinions

About a year and a half ago, my dermatologist who originally diagnosed my suspected "melanoma in situ" said to me that we probably treated this "more aggressively than we needed to."  Meaning that the skin they removed from my cheek was not actually melanoma in situ, though those cells could've had the potential to turn into that in the future. And a skin graft probably was not necessary (though she didn't use those words--she insinuated). I felt a sinking feeling, a regretful sensation.

Since my dermatologist had sent my biopsy to her colleague in 2009 for a second opinion, the confirmation from a second source was enough to help me make the decision to go ahead with the skin graft that I'd been strongly advised by my highly trained, well-schooled dermatologist to undergo. But everything surrounding that diagnosis felt uncertain to me, which is why I researched the types of stains that the pathology labs use and found that some read differently and it's not always a "sure thing" that it's a melanoma cell. I never felt that I could get enough information prior to my graft surgery. I couldn't find what I needed to be certain. I was searching for information and felt extremely under-educated about it, so I went blindly into the skin graft because I had been advised this was what I needed because the doctor sincerely expressed how serious (and deadly) melanoma can be. Scared the heck out of me.

I sat quietly on this for more than a year and didn't mention it here because I'll never know exactly why they went ahead and decided to cut so much of skin away if they weren't absolutely sure. I don't know why I didn't press further to be absolutely certain I needed it done. The doctor said to me that these cells weren't melanoma in situ "yet" but could potentially turn into that in ten years. This doctor seems like a very sincere, nice human being. Regrettably, I now have a big scar that probably wasn't needed, and if the brown spot on my face had been removed without taking such a large surrounding margin, I'd still have a scar but wouldn't have to be concerned about the spot any more (nor its potential to become cancer cells). In other words, I probably would have had it removed, but not with all the good, healthy skin surrounding the spot. The remaining scar would have been much smaller and I wouldn't have gone through such an emotional ordeal.

I didn't want to write about it here because I thought it may deter people from going to their dermatologists. That could cause some very serious cancers to be missed! 

But I have to write about it today because I recently heard from one of my blog readers who has kept in touch with me via email since 2010. Unbelievably, she too has learned that a similar strange scenario occurred in her situation. Her new dermatologist reviewed the paperwork in her case and said she had not had melanoma in situ either! But she underwent the graft surgery thinking it was necessary at the time, just like I did.

So some diaganoses of "skin cancers" are not that at all, and apparently some people have had skin grafts unnecessarily. I only know of myself and one other person, so I don't know how widespread this is.

In hindsight, I think Mohs surgery would have been better in my case. Since my original spot was continuing to get larger with time, it is certainly something that should have been removed. I would not have just left it there to grow and worsen.  

Nevertheless, I still went through it and I still have a scar. So I'm leaving the blog as it was written. I was led to believe I had melanoma in situ, so the emotions I experienced in 2009 still apply to those people who have it. And all the photos I've posted show how a skin graft looks, for those who unfortunately have to go to that extreme to remove abnormal cells. Cells, which I hope, have been accurately confirmed by more than one opinion.

Thanks for letting me vent.

Scar Progress ~ Four Years

Four years later (no makeup)

Some Septembers have passed since the surgery in 2009. I almost forgot... but last night a fleeting memory blurted into my head reminding me ... it was this time of year when I had such a nerve-wracking, face-changing experience four years ago. Here's how it looks today.

Milk Thistle May Protect Against Skin Cancer

I've been trying to find more information about this, as it sounds quite promising...

"A bright purple flower could play a role in protecting against skin cancer, according to two new studies.
New research from the University of Colorado Cancer Center shows that not only does milk thistle extract, called silibinin, protect against skin cancer-causing ultraviolet-B (UVB) radiation, but it also kills cells that have undergone mutations due to ultraviolet-A (UVA) radiation -- a process that would potentially lead to cancer."

I have ordered some milk thistle extract to apply to my skin. There are also capsules, supplements, which can be taken internally. If the silibinin can actually protect against and kill mutated cells, I think this is very big news. Will have to wait and see what future studies have to say.  For now, I'm doing my own study at home!

August 2013

Autumn

Still wearing a hat. It's a simple way to help protect skin from sun exposure.

Three Years Since Graft Surgery

Three years ago this month I was going through the graft process, and thankfully three years makes a big difference in how a scar fades. Here's how it looks at the 3-year mark.

Just wanted to mention something because today's date is meaningful to me. My grandmother died a few months ago. Today would have been her 100th birthday.

Summer 2012

Blue Lizard SPF 30

My new favorite brand of sunscreen for the face: Blue Lizard.

Blocks UVA/UVB. Not greasy, not too filmy white, but a bit on the expensive side. While researching I was amused to learn that Blue Lizard also sells "economy" gallon containers (for $250).

April 2012

Just came across this article

Regarding stains used by pathologists to determine types of cells...

Melanocytes in Long-standing Sun-Exposed Skin
Quantitative Analysis Using the MART-1 Immunostain
Ali Hendi, MD; David G. Brodland, MD; John A. Zitelli, MD

"PHYSICIANS WHO DIAGNOSE melanoma histologically or who evaluate the surgical margins of melanoma often face the difficulty of distinguishing nonmalignant melanocyte hyperplasia from melanoma in situ in sun-damaged skin.

...With such uncertainties, many physicians most likely err on the side of over diagnosing melanoma in sun-damaged skin to avoid the obvious medical and legal consequences of not diagnosing true melanoma.
Over diagnosis, however, leads to additional and unnecessary surgery, morbidity, and deformity."

Here is the link to the full article. Before undergoing surgeries, ask questions of your doctor and get a second opinion on the pathology if you can.

http://archderm.ama-assn.org/cgi/reprint/142/7/871.pdf

March 2012

Time marches on, seasons come and go, and skin grafts heal.

I Started This Blog Two Years Ago

Two January's ago, I sat down to write about my skin graft. I never thought my words would be read by so many.

Now it seems I have skin biopsies every six months when I visit my dermatologist to be sure other melanoma cells aren't developing. Or have a spot frozen, like so many people do. So far, so good. I've had one scar revision on the graft which made a slight improvement and makes me feel better.

I've seen notes and stories posted here from blog visitors who have gone through similar experiences and others much scarier than mine. I wish none of us had to go through it, but honestly it has helped me tremendously to read all the supportive, uplifting stories. It's also quite sobering to realize how often people are going through these procedures that change the appearance of our faces in some way. We are fortunate the doctors are finding and ridding us of these things, but it seems like there must be a better way.

I often think about how many other people aren't having their skin issues addressed at all, and they have no idea how a freckle or a mole can be damaging their body internally. And to make it even more worrisome, a small number of cases are amelanotic melanomas (those without color) or found under fingernails or toenails.

Here is my "progress photo" today, a much smaller area to deal with than I showed you two January's ago. I look and feel like myself again.

My new favorite "scar products" are oils. I apply either pure coconut oil or pure argan oil directly to the scar at night. Other people have mentioned that they use homeopathic remedies or a certain type of healing honey. Anything that helps make the skin soften and promotes healing. Here's to a healthy 2012.

January 2012

Happy New Year

After Scar Revision

It was just a small "repair" but had a positive impact on me mentally. One small edge of my scar was removed (close to my nose) and it has made me feel better about the entire thing. The scar is still there on my cheek and always will be, but the negative feelings about it continue to fade.

October 2011 (after the scar revision)

October 2011

 

BEFORE  (July '11)

Two Years (and a day) Since Graft

The graft scar improved and softened noticeably over the summer, so I arrived at the 2-year mark with a decent looking scar finally. But I still wanted to undergo a revision of the stubborn raised tissue near my nose which was always white. Monday I had it done, and I'm glad I did. My surgeon performed this minor procedure in his office while I sat in the chair. The sutures are staying in for a week, and there was no bruising or swelling. I believe the scar will ultimately be softer and slightly smaller in the long run. I had this done because it is my face and I'm still a little self-conscious about it. By this time next year, I expect the scar will look smoother than it ever has. Through this entire experience I have learned a couple of things: hurry up when you hear the melanoma word (and get it removed), then be very patient while your scar heals. Patience, patience. And even little freckles can be melanoma.

August 2011. This photo also shows the scar on my collarbone where the graft skin was harvested in '09, plus a white scar above my lip where a precancerous lesion was "frozen" off in 2010.

Scar revision September 2011

The raised scar tissue has been removed

Optimistic About Scar Repair

Next week I'll have my first (and probably only) scar revision. I'm excited and nervous. Waffling between feeling vain for wanting to remove a small bit of scar tissue to believing that after two years I somehow deserve to have a little repair done on the scar that never healed very well in the first place. Mainly because this is on my face. If it were located anywhere else on my body I would not be the least bit interested in fixing it. I have felt in my gut that this particular ridge of scar doesn't belong on me, and remain hopeful that my very minor slice & suture in-office procedure will allow that spot to blend better with my skin after two years of looking at my scarred reflection. The graft scar will always be there, but this is one way of making it ever-so-slightly smaller and less noticeable. Never looking forward to having my face cut, especially on this voluntary basis, but I'm feeling optimistic that it will give me a sense of completion on the whole graft thing. It's my way of taking control over it in some small form. When you're first told that you need a skin graft, there is a feeling of loss of control over the entire matter. I'll post photos as it heals.

Two years since the dermatologist said the words "melanoma in situ"

The scar keeps getting softer. Biopsies on other cheek a few months ago were negative, thank goodness. I have a September appointment for a small scar revision. The pink on my face in this photo was from being overheated from hiking, not from sunburn. I honestly haven't had a sunburn for two years. In past years, getting a little pink from the sun would have been a normal, routine occurrence during the summer months for me, and was often what I was aiming for. Not any more! Although this summer my arms are getting a little tan from being outdoors for short durations without sunscreen, which worries and pleases me at the same time.

I think about the graft less, don't feel as self-concious about it. Was having a routine colonoscopy last week and noticed that medical staff are quite open about commenting on the graft, and easy to talk with about it.

Have a good summer and stay cool in the shade.

My Shiny Circular Scar

March Update

I've been hearing from a few people via email who have been going through similar experiences. I'm pleased to report that most people aren't bothered by their scars after a while. Here's how mine looks after a year and a half. A little lumpy and crater-like, but blending more with my skin, and an okay color (compared to a year ago).

Here is a website that has a lot of information about sunscreens and other products, along with their ingredient listings.   

Environmental Working Group

www.ewg.org/2010sunscreen/

This is probably old news to some, but I didn't know until today that some plastic surgeons use leeches to help heal grafts! 
Leech article:  
http://www.msnbc.msn.com/id/5319129/ns/health-health_care/

Also important to mention, and was suggested by a fellow reader--people should be made aware that full body screenings are important. If you've had a skin cancer experience, especially melanoma, it is important to have your eyes examined as well as your private parts. Yes, as surprising as it may sound, melanoma can occur 'where the sun don't shine' and within the eye. UV exposure is damaging to eyes and causes many of the commonly known eye problems. Sunglasses are your first defense there. My dermatologist suggested this at my first full body examination. Since that time, I have taken my daughter for a full body screening (she is 11 years old) an my husband also went for his a few months ago. And I visited the eye doctor!

Thanks Shelly, Tammy and Joyce for your recent correspondence.

Looking Back ~ Reflections from 2009 Journals

Being a life-long journal writer, I naturally turned to my journal to express my feelings about this experience. So here I've extracted relevant bits and pieces from that difficult period of time.

The pictures below depict the process in a nutshell. The first photo is from the year prior to surgery, then a closeup of the brown spot in July 2009 after it was biopsied...then September & October healing after surgery. The picture at far right is a recent picture taken in December, 2010(which was 15 months after surgery).

July 29, 2009: 

Met my plastic surgeon yesterday and he'll do a skin graft September 15. He didn't make me feel any better. I dread it all. I hate this damn brown spot and all the grief it's causing--all from the sun that I love and hate. I try diligently to keep sun from shining on the spot now. The circle of the excision will be quite large. I gulp at the thought of seeing the outcome. So much trepidation, anxiety and worry.

August 29, 2009: 

Life's dealing me a rough patch. I don't like it, but there's nothing I can do but march forward and press on through it. Try to see the bright sides...there must be some. My optimism has been thrown off a bit. I'll have to get over the hump, the hill. At least it's not a mountain.

September 10, 2009: 

Just a big pain in the neck, all of this. Dr. M says melanoma that is removed sometimes recurs in 5 years or more. So I'll have to be diligent. This is all a big inconvenience, somewhat life changing too. My face will never be the same after Tuesday and I have some grieving about that. I think the hardest day will be seeing what's under the bandage when it comes off. The doctor said I'm going to look a little "rough" for a while and that I'm not going to like it.

September 12, 2009: 
I'm getting used to having a lot of anxiety surrounding all this and it feels like a very long road before me. Gives me sadness and worry because melanoma can be deadly. I was very productive today, washed all the sheets. Will get a good supply of groceries tomorrow because I don't want to go anywhere for a while. Dumb face! Why did you have to get cancer right there? I'm having trouble processing it. Must keep taking deep soothing breaths.

September 15, 2009

Day of Surgery

A very high anxiety morning. Surgery was about an hour late getting started but went fine and we got home just in the nick of time before L's school bus arrived. I was a wee bit woozy on our car ride home. I'm using Tylenol rather than the pain prescription they wrote. I think I can get through it with just Tylenol. I have to sleep with my head propped up. Glad it's behind me. Hope it's all overwith. Big suture line where the skin was taken near my collar bone.

September 17, 2009:

As I was looking out that hospital window two days ago, the scenery was quite pretty. It reminded me of being in the hospital when my baby was born 10 years earlier. But as I said to my husband, that Vermont hospital birth experience was more like Christmas because we got a "present" at the end. With this hospital adventure, there was no present at the end. Today I didn't need any Tylenol. No pain. Friends being encouraging and helpful, and my husband & daughter are taking good care of me, even washing my hair. I feel cared about and cared for.

September 18, 2009:

Looks like I have a black eye, but yellow-green skin today. And very itchy. The area looks so large and has puckering skin around the yellow bandage. That pressure bandage is icky and is in my way. Haven't needed to take anything for pain. Collar bone stitches feel tight but not painful. It's all good. Just an emotional adjustment. I feel vulnerable and self conscious. Going through a transition. Reality sinks in from time to time. But I don't cry about it because a)other people have much worse problems, and b)I'm not supposed to get the bandage wet. I'm giving myself a week to not feel guilty when I take a rest or just sit still for a while. I'm still being productive, just don't want anyone to see me close up. The yellow bandage is a bit startling. It is sewn to my face.

September 20, 2009:

I'm wanting friends to see my face as it is now (via photos) so it won't be such a shock to them when I finally get the nerve to show my face to the public. But with this yellow thing I don't want anybody to see it just yet. Only two more days with this hard gross yellow thing on my face. I can't wait to have it off me, yet I'm extremely apprehensive about seeing the graft. My skin will have to get a chance to settle down after the trauma. I still can't believe that harmless little thing was melanoma. Harmless looking, but not so harmless. Cutting out such a big piece of one's face must mean it's pretty serious. Damn it's an ugly sight. My symmetry will be gone. It saddens me. Sort of startles me when I see myself in the mirror. At times I look at it and think it's healing well, swelling subsiding. Then I look again later and it looks scary to imagine what's under the yellow, and if it is working, if it's ever going to look un-puckered. Pink and red around all my sutures now. Well it totally sucks and is very much not welcome in my life. 
  Today is our 13th wedding anniversary, and it feels so incredibly wonderful when my husband washes my hair! The warm water and clean shampoo is tremendous, as well as his loving hands.

September 22, 2009:

On our way to soon have my "tie over" yellow, icky bandage removed. I have apprehension about seeing the graft. Squeamish, queasy-ish. But at the same time I want this darn hard foam thing to come off. Nervous to see Dr. M today but not nearly as bad as one week ago!

Later 9/22:

   It looks really horrible. Dark! And it hurt taking out the sutures. I can't believe I need to go back there again in two days and then two weeks later. My goodness it looks disgusting. Like a crater on the moon. Dark and gross.

September 24, 2009:

Today I was relieved to get the final sutures removed. Martha (the nurse) taking them out made my eyes water but it didn't hurt as much as Tuesday. Felt good to get them out. Just Martha and me at the office today, quiet and peaceful. Martha's concerned about the dark scab at the top and the other spot near my nose. I could tell by the look on her face it wasn't the best result she'd ever seen. I think it's not going to heal very smoothly, although she did remove some dead tissue so the wound looked more pink and not as menacing. Still, though, looks like someone put a car cigarette lighter on my face, like a burn. I'm choosing to call it pepperoni. It does look like a piece of pepperoni is stuck on my cheek, or at times looks like a whole tiny pizza sprinkled with some toppings.

   My daughter saw it for the first time tonight and she was fine. She was very supportive and very curious. She handled that very well for a 10 year old. Yet I'm startled when I look in mirrors. Is that really me? Because I can't even feel it, and I forget. And it's not an integral part of me yet. Weird stuff.

September 27, 2009:

My parents came over with hot sub sandwiches today. Was the first time they'd seen me since surgery. They both said it wasn't as bad as they expected, which is what my brother said after looking at photos. Today it looked promisingly better and pink, but the darn black necrotic tissue areas are very dark and distracting. I think, though, that I am healing rather quickly and can see tiny differences each day. But this "rope like" perimeter of skin where it was tightly sutured to the bandage is not softening. So that bugs me. But it'll all get better I think. Maybe in six months it will look decent.

October 1, 2009:

I'm healing but not ideally. There's too much dead tissue in the way. The scar is getting to be oddly shaped and lumpy. I did chat with the mail lady yesterday--I was brave. Talking to people makes me feel very exposed. I hate it. I will be 48 in three weeks. But glad my 47th year is going away because it's been a weird one. Move on, move ahead.

October 7, 2009:

I've been back to Dr. M and was told to do scar massage 10-20 times per day to flatten the outer rim. I don't remember to do it often enough. Must remember all day!

October 11, 2009:

Once in a while I get frustrated with how long this graft is taking to heal. It looks very bad still. Very red, rough, pink, bumpy. Big! Noticeable as heck. I forget it's there and then realize day by day that it's on me forever. And it's going to take so long to fade. It's a slow process. For some reason grafted skin is slow to heal generally. I love everyone's support, just feel sad or frustrated (or bitter perhaps) that this happened to my face and that I have to put up with it for as long as I live. It will age with me. I'm a strange looking person right now. Have to explain my wound to my daughter's friends and their parents.

October 12, 2009:

I've had my graft about 4 weeks now. Feels longer than that. I wish I could just peel it away and be my normal face again. I don't like to do things that involve face-to-face communication any more because my face is rather shocking. I'm trying to get my nerve up to go the grocery store tomorrow. I'll probably put a bandaid over it. Still very colorful, pink/purple/red. Scar massage seems to be bruising the skin so I haven't seen it improving this week. Nor has it been contracting or shrinking much either. I am really hating it, resenting it. Feeling stifled by it. Self conscious much more than I ever used to be. I hate telling new people who didn't know I was having this done. I hate the awkwardness, and they don't know how to look at me or what to say. But it's like an elephant in the room if I don't say what this is on my face.

October 16, 2009:

Once in a while I'll be applying lotion to my scar and I just start to breathe quickly as a weeping sensation comes over me involuntarily. Tonight it was because it's so shiny and different from my regular skin. Lumpy. Purple. Oddly textured. Big. But when I glance in the mirror at the graft cheek--usually when I'm very close up to the mirror--it just makes me well up with tears. It's a deep, sad feeling. Helpless. No hope in sight for it to ever heal well. It's so far from looking even remotely close to healing or flattening or blending. Long road ahead with that.
   Monday Dr. M told me to press harder on my scar when massaging. Ouch. Another day, another doctor :)

   I wore a bandaid over it when the blacksmith came to do the ponies' hooves today. He was very nice about it and wanted to hear about it. He has a family history of melanoma. his sister and grandmother. His grandmother died from it. I've been hearing about quite a few deaths from it lately. So I should just be grateful for my life and stop worrying about the dumb scar! But I'm not quite there yet.

2004 - brown spot was there and I was vacationing in the sun

Nearing the 18-Month Mark

Next month will be a year and a half since my graft surgery. It's beginning to feel like "history" now which is refreshing. Looking in the mirror is always a reminder but the healing continues. I've been touched by the comments from people who have shared similar experiences. I'm grateful to those who have shared their stories with me, along with their photos.

When I meet new people, I sense how they are looking at me; just trying to figure out what that might be on my cheek. But the stares aren't glares like they used to be--simply natural human curiosity. Most people have no idea what skin grafts look like, or why a person would have a circular scar like this. So I understand them wanting to look just a little bit longer than a person normally focuses on your face when you meet or shake hands etc. Nobody has ever actually asked me what the scar is from, but I can feel that I'm being looked at in a particular way. I have finally developed an ability to let them look...without wanting to turn away.

Unexpected Compliment

Yesterday my daughter (age 11) said "Mom, I don't even notice your graft scar any more." That meant a lot to me.

It's More Tolerable With Time

Perhaps it has been the distractions of the holidays taking my mind off of it for a while, but I'm very happy to say my scar has been fading into the background of my thoughts more and more. It seems to be blending better over the past few months and isn't quite as visible. I'm less apt to feel the need to "hide" or avert my gaze, and it seems that people aren't staring at it any more. I'm attaching December photos, which show the progress at 1 year + 3 months since surgery.

Depending on the angle of sunlight, the scar sometimes shows prominently in certain photos while in others it's not so obvious. I've been wearing sunscreen all winter.

One Year Has Passed

Today the weather is almost exactly like the day of my surgery last year on September 15th but today I am able to thoroughly enjoy the day. I remember that morning so clearly. My husband was with me and every time he looked at me while I waited my turn I felt like crying. His eyes were reflecting my worry. I felt worried and sad that my face would forever look different, and knowing that when he would gaze upon my cheeks in the future, it wouldn't be the face he fell in love with. He has been so wonderful about the entire thing and all along he has said it doesn't make a bit of difference to him.

That is what I remember most about the morning of my surgery, and also the moment I awoke from anesthesia. I could hear the nurses talking and the first image in my mind was that of our pony's little round buttocks. What a silly thing to think about! It made me smile. Then I got ready to go home, they gave me some ice to hold on my cheek, and I was seeing double all the way home. Probably due to the proximity of the surgery to my eye. I was just glad it was over. The healing felt slow but looking back now, I can see a continuation of progressive healing. And it's still getting better each day.

I had my 'one year' appointment Monday with the plastic surgeon. He was pleased with how much better it looked since last time and said he doesn't know why it's taking so long to settle and soften, but in 6 months he will see me again. At that time the ridge of thick scar tissue closest to my nose may be softened enough to excise as a scar revision procedure. Too soon to do that now because it could just scar more. My hope is that in 6 months it will just be soft and faded enough that I won't feel the need for any additional cutting or "revisions."

So this is what that once-horrible thing looks like after one year...and it is certainly better than having cancer.

September 2010 ~ One Year After Graft

It's been almost one year since surgery. Here's how the graft looks without any makeup today. I admit this looks a lot better than last September. Not so much of a glaring mark any more, though makes me feel asymmetrical.

July 2010

June ~ Went to the Beach

Had a nice week at the beach and kept myself covered up with clothing or sunscreen. Didn't get any sunburns! From a distance, can barely see the graft scar. But up close, it's still a circular bumpy discolored patch. The collarbone scar doesn't bother me any more.

                

June

Smoothing out a little

How the Graft is Looking 8 Months Later ~ May 2010

From a distance it's not too bad, but up close a definite scar. I've been using so many scar products on it. I'm not sure if they are helping at this point. I also try to massage the scar every night.

April 2010 Update

April 2010 pictures, seven months after skin graft on cheek. Perimeter is softening better, ridges and bumps less noticeable. The grafted skin seems to dip since there's not a layer of dermis underneath any more. I will be seeing my dermatologist in two weeks again. Last month the plastic surgeon told me this graft will probably start to blend better by September of 2010 which will be a year after surgery.

Recent Pictures ~ Graft Progress

Winter 2010

I don't wear my sunglasses into the stores as much as I did before.
The graft surgery was performed 9/15/09, so these photos show progress at approximately the 5th to 6th month.







March 2010
This shows the new wrinkles (caused by the scar) when I smile.
 

My Skin Graft and Melanoma in situ

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

Morning after surgery

September 16, 2009 evening

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."

September 19

September 21

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.

September 25

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

Now October...

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.