Facing Melanoma: 6. More Scarring: Wide Local Excision (WLE)

January 2014. So my dermatologist has told me that I must undergo a surgical procedure called Wide Local Excision (WLE). This is scheduled for about four weeks after my diagnosis of malignant melanoma. The rationale for the surgery is crystal clear. Basically, during an excision biopsy only a small area of skin surrounding the suspected melanoma is removed. If mm is confirmed, additional healthy skin must be removed around the site to ensure there is enough 'clear' tissue removed (usually around 2cm but this depends on the thickness of the mm too). This minimises the probability of future local recurrence.

I am upset. I am slowly coming to terms with everything that is happening to me. I try not to think too much about the cancer diagnosis per se and any potential long term consequences (such as the 'it may kill me' bit). But I hate the fact that mm is already messing about with my current plans, with my short terms objectives in life. In that period I have enrolled in a part-time fitness course to qualify as a personal trainer (as I love fitness and I think it's great to have hobbies and interests which are unrelated with my full time job in the insurance world). So I want to be reasonably fit, I am exercising a lot and I am loving my fitness routine. Just how inconvenient is it to have to undergo a surgical cut (not a small one this time unfortunately) and be unable to train for at least 2 weeks?! So in the last couple of weeks before surgery I go to the gym every single day and I work out extra hard. With every step on the treadmill I may be running away from mm, but with every weight lift I am punching it right in the face. Frustration sky high.

30 January 2014. My WLE is done as an outpatient procedure by the dermatologist under local anaesthetic. I subsequently found out that such procedure is more often done by a plastic surgeon, especially when it involves a skin flap or graft, which will depend on where on your body the procedure needs to be done. A flap or graft means that the skin removed is then replaced with skin from elsewhere on the body. Mine is on my back, so not particularly complicated (no flap or graft is required) and my dermatologist is a mm specialist, so he does it himself. Literally a piece of the skin is cut off and then the wound stitched back together. Now at the time of writing I cannot help but thinking that a plastic surgeon could have done a neater job, but the most important thing is that the job is done, and the look of a scar, which I cannot even see, is not a key concern at this stage.
The procedure does not sound so bad to me, but it is actually a little worse than I anticipated. There is no pain at the time of course, due to local anaesthetic, but it's hard to ignore the smell of burnt flesh (cauterisation is used to burn the surrounding tissue around the cut to stop the bleeding). Fortunately my mm (primary tumour as I might call it now) was on the top of my back (right under my neck) so during the WLE I am lying on my tummy and my back is an area of my body that I cannot possibly look at whilst the dermatologist is carrying out the procedure, even if I was really tempted to do so for some obscure reason. I am therefore spared any graphic details (and so are you). There is always a bright side to everything!

Pain is quite bad over the next few days. Up to 10 days afterwards. I think I was only off work for 2-3 days. I would recommend that anyone who has a WLE take at the very least one week off work (and this is for sedentary work). Thinking about it all now I realise how this procedure was more 'heavy' than I had anticipated, I was not mentally prepared for it. I faced it by pretending that it was just a 'little cut'. Now I realise how upset I really was, and how this physical and mental burden, which I was trying to see as a 'matter of fact' medical appointment, left more scarring than expected, both outside and inside me.

I am feeling positive at this stage. I go back home and I see this as the starting point of my healing process and my full recovery. The end of my fight with mm. Little did I know that soon I would have much bigger battles to fight against the same evil.