Ok…so here is the perspective from someone who had a Wide Local Excision on his foot from a 3.7 mm deep melanoma.
For invasive melanomas with Breslow thickness ≤1 mm, the recommended clearance margin is 1 cm of normal skin. For melanomas with a depth between 1 and 2 mm, surgical margins of 1 to 2 cm are the goal. For melanomas between 2 and 4 mm in depth, margins of 2 cm are recommended.
In my case, the margin that the oncologist was trying to achieve was 2 cm. After the oncologist did the best she could do in removing the desired margin of tissue, she then turned me over to the plastic surgeon. His job was to close the wound. The reality is that you can only stretch skin so far before it will just rip, so depending upon the size of the gap and the location on the body, a skin graft is often necessary.
In my case, I had a hole on the heel of my foot about 3 inches in diameter, and down to the bone and cartilage. To close my "wound" required a full-thickness skin graft which was taken from my upper thigh. The procedure involved microsurgical connection of the blood vessels of the graft to the blood supply within the remaining tissues of the foot.
One big reality that you must accept in dealing with a medical procedure is that the doctors have protocols for performing all procedures, which have been developed over many years, and the doctors will adhere to those protocols in order to ensure the best outcome. They may listen to their patients' requests, but ultimately, they will almost invariably follow the protocols dictated by the circumstances.
You really need not try to be the "hero" in saying that you do not care about the aesthetics of the outcome. Under these circumstances, the doctor will do the absolute best they can do…nothing more…nothing less. Also, you want the doctor to feel you are working with them, not against them. As a board-certified plastic surgeon, the outcome they achieve for you is their "work" and they will want it to meet the standard of care that they, as a medical professional, have been trained to deliver.
Mark (IIA)
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