I'm having a flap or graft done on my face due to cancer. This will be on left side of face, cheek area. They said the whole cheek must be done as the melanomas are all around. What can I expect? Thanks.
What to Expect with Graft on Face Due to Melanoma?
Doctor Answers 6
Extent of reconstruction depends on size and depth of melanoma
Melanoma skin cancer on the face can be life threatening. The extent of the reconstruction depends on the size and depth of the melanoma present. The size of the defect also depends on the location and whether or not there are any lymph nodes involved. The thickness of the melanoma will determine final treatment parameters. Most certainly there will be a scar present from the removal and any type of skin grafting necessary to close the defect.
Treat The Cancer First
When dealing with cancer reconstruction, it is imperative to keep goals in order. First and foremost is treating the cancer. With melanoma, the depth that the tumor has invaded into the skin will determine the amount of tissue which is to be removed, including normal appearing tissue around the tumor. Second and also important is reconstruction. Unfortunately, even the best reconstructions will produce scars and will not look exactly like things did before surgery. The result will depend on many variables, not the least of which is the skill of the surgeon. Just remember though - treating the cancer is always paramount. Be sure to pick a surgeon (or sometimes a team) who will do what is right for the cancer treatment and not necessarily what will produce the least visible scars.
Melanoma of the cheek
We treat cancer first then do the best and leat noticeable reconstruction possible. It is always best to replace like with like if possible. Local tissue is always better if available.
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Cure over cosmetic concerns in the case of melanoma
Most common type of melanoma on face is lentigo maligna or melanoma in situ. However, there have been several reports of metastasis even in the case of melanoma in situ on the face so adequate margins should be taken to ensure the highest cure rate. Your surgeon along with your dermatologist may recommend lymph node biopsies as well depending on the depth of invasion of melanoma.
Cosmetically, flap almost always looks better than a graft, however, in the case of melanoma in situ or melanoma, graft may be preferable in case there is a positve margin as it would be much easier to go back and perform re-excision versus a flap where there can be significant amount of tissue movement. I am certain the procedure is performed in close coordination with a board-certified dermatologist who can perform Woods Lamp examination to better delineate margins of melanoma on the face. Topical imiquimod may be advisable to increase cure rate, better appreciate residual precancerous burden on the rest of the skin based on the amount of subsequent inflammation from imiquimod and possibly improve the appearance of surgical scar. Best wish.
What to expect with facial reconstruction due to melanoma?
Melanoma is a very serious disease in which the best chance for cure depends on the thickness of the tumor and on complete removal of the tumor as well as its closest lymph nodes. In the face this means removal of a margin of skin without tumor as well as the superficial lobe of the Parotid (salivary) gland which contains the closest lymph nodes. Depending on the finding of tumor on not in these nodes, further surgery may be needed.
The reconstruction depends on the extent of skin removed. It can be done with skin moved from the upper neck or in large cases by portions of skin moved and reattached microsurgically from other parts of the body.
Senator John McCain had a left facial melanoma removed a few years before he ran for the Presidency in 2008.
Good Luck. Hope everything turns out well.
Peter A Aldea, MD
Depth of melanoma is single most important factor in determining management
This is difficult to say based on the information you have provided. Treatment is based on the thickness of the melanoma. Deeper melanomas require wider excisions. Wider excisions remove more tissue with greater risk for involving surrounding structures. Furthermore this will require a more extensive reconstruction.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.