I’m Ready to Remove the 15year Old Scar/skin Graft on my Shin
- Asked by ReillySF in San Francisco, CA
- 2 years ago
I had melanoma removed in the early 90's and they took out a large circle, the size of a soda can, right on/next to the bone and put in a skin graft, the graft was taken from my thigh. Most doctors seem to have a specialty, my scar doesn't fit into a category, so I'm not exactly sure what kind of plastic surgeon I should be looking for any suggestions?
Scar revision after melanoma excision
I'm delighted to hear that you've had no further melanoma problems since your initial surgery. I can thoroughly understand your desire to have your scar removed - most people like to leave their melanoma memories behind them!
A plastic surgeon with an interest in reconstructive procedures would be most likely to be able to help you.
I would suggest that the skin graft be serially excised and that fat grafting be done to the area under the skin graft. Excising the skin graft will leave you with a longer scar, but it would address the contour problem and provide a better skin match. It would not be possible to remove the scar in a single operation, so be sure to ask plenty of questions about the number and length of treatments that a surgeon anticipates before proceeding with surgery.
Unlike most other skin cancers melanomas are removed as a core of skin and fat all the way done to the muscle level. Most other skin cancers are treated by removal of some of the skin layer only. This has left you with an indent where the fat layer used to be and surface skin that is visibly very different than surrounding skin. The indent is best treated by free fat grafting. The surface skin is difficult to removed because there is little no surrounding skin laxity i.e. you can't just cut out the scar skin and close the resulting wound.
My suggestion would be to first address the indent with free fat injections and then do small serial excisions of the grafted skin in an attempt to get the surrounding normal skin to stretch sufficiently to allow direct closure.