› Forums › Cutaneous Melanoma Community › Wide excision biopsy of foot
- This topic has 24 replies, 4 voices, and was last updated 9 years, 7 months ago by
Cynlee.
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- January 26, 2016 at 7:19 pm
I wanted to share my story since I am going in for a biopsy for an atypical mole on my foot. It will then be sent to a pathologist and it's irregular, discolored and with black dots. For those of you with short attention spans, I'll ask my question now before I share. I am having a wide exision biopsy on my foot? How long was your recovery? What was the procedure like?
Now that my question is out, I also wanted to share my story because I'm scared and I've already learned so much from reading this Bulliten Board. Today is the day I audition for a dance company that I've been training several months for. I'm 30 and even though I was overweight and miserable for most of my early schooling, I had a great life change in my 20's and started to salsa dance more intensely. The irony of it all was that I was told I was not the ballet type when I was 5, but Salsa is like ballet with congas!
It took me a long time to feel comfortable in my body. I hadn't seen my doctor in a while. I had a blood clot in my leg that traveled to my lungs (pulmonary embolism) when I was 24 but this is the healthiest I've ever been. I got really sick with a random virus before Christmas and booked a last minute appointment to show my doctor a growth on my pinky toe. It wasn't discolored but she sent me to a podiatrist to have it removed. What I thought to be a superficial visit to the podiatrist became a concerning visit. I actually felt weird going to the doctor for it.
The Podiatrist looked at my toe and then started asking about another mole on my foot. I've had this mole since I was a child. I've had two and while one of them has faded, the other has become more discolored and dark. I made a joke about it and then the Doctor looked at me with a look of concern I couldn't shake off. He asked me if anyone in my family had skin cancer and then took a step back and said, "You need two surgeries and I'd like to do that in my outpatient clinic at Beth Israel Hospital in Boston.
He then asked, "Can I draw on you?" My first reaction was, "Can I audition on Tuesday?" He didn't look amused or say anything about dance. He then drew the shape of an eye-lid on my foot. He explained how that I needed a wide-local excision. At that point, between his concern and urgency, I felt scared. I asked if this is something that could happen on an existing mole and I can't remember what he said. All I heard was, "My staff will call you from the hospital," and there I was sitting in the doctor's room alone.
I left the office and went for an x-ray. He said that the grow could be an extra bone but also wanted to remove the mole and the skin underneath to have a biopsy. I usually have a delayed emotional reaction to things. I'm really good at responding to a crisis but this visit was different. I called my primary care doctor since I need to get clear for surgery and she said that I'd have to go on medication before the surgery since I've had a pumonary embolism and bed rest is risky for me.
I took a good long look at the mole when I got home. It's irregular, two different colors and I have some black dots on the side. I remember is scabbed the last time I went on vacation. I also have a new one that appeared on the sole of my foot. I'm scared and in what I've read I have a lot of respect for those with Melanoma. I do not have an diagnosis since I am days before my surgery but I kept telling my friends two weeks before this happend that I felt like I needed to start juicing and change my diet to feel more energy. I've been calling the office everyday since the doctor needs to submit his notes in order for me to be scheduled. He hasn't done that since Thursday.
I know it could not nothing, something, or life-changing. Either way, foot surgery at the peak of my dance is really upsetting. I went to rehersal last night and cried the whole way home. I wanted to ask if anyone else has had a wide exision on their foot and if so, how long did your recovery take? I obviously won't be able to place any pressure on it and I walk to and from work.
Any advice would be appreciated and for those actively fighting melanoma, I thank you for sharing your story. It's helped me a lot during this time of uncertaintly. In my gut, something wasn't right about that visit. When I played sports we always had to get to know our opponent to create a strategy. I feel like the more I read, the better I can be prepared but at the same time, I just want to know what's going on with that mole.
Thank you for reading and sharing in advance.
<3
- Replies
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- January 26, 2016 at 7:55 pm
My first question is – does this podiatrist know anything about melanoma?
I have one initial concern. Why isn't he just doing a biopsy – say a punch biopsy? The thing is, let's just say worst case scenario that this is melanoma. If this did happen to be melanoma, you typically would have a biopsy done first. Then if this happened to be a deeper melanoma, you would then schedule a surgery date that would start with a Sentinel Lymph Node Biopsy (SLNB) — this checks for possible spread to the nearest lymph node basin — followed by the Wide Local Excision (WLE). They are done in that order for a reason. The WLE may alter the drainage path making the SLNB inconclusive. Typically, the SLNB is ALWAYS done first before a large chunk of skin is removed — then the WLE. Now, it is possible having the WLE done first will not change the drainage patterns, but no one can know this for certain. If they did the SLNB later, they may find "A" sentinel node, but will it be "THE" sentinel node that would have been found prior to the WLE? No doctor can guarantee this.
I honestly think that the podiatrist — if he truly suspects melanoma — should at least consult with a dermatologist that knows melanoma. Because doing the WLE first raises a red flag for me. If this mole is NOT melanoma or a very thin/early melanoma, then the SLNB would not be indicated and the WLE would be the only course of action. No problem, you just have to heal from the WLE and you are good to go. But as I said, if this was the worst case scenario – a deeper melanoma — then doing the WLE first may compromise staging information.
You need to do what makes you comfortable. I have not had a WLE on my foot but have had several on my legs (one on top of shin bone) and they are very tight and walking – let alone dancing – will take some time. You do not want to split the stitches because that will only mean healing will take much longer. Is he also planning to do other bone related surgery on your foot? I did have bunions cut out years ago on my baby toe where they broke those toes. Honestly, with broken bones healing on my feet, it was a 6 month healing time before I felt comfortable playing tennis – my activity of choice.
Again, I am only really bringing up the worst case scenario and you might choose to think this isn't something you want to think about at this point. That's totally valid. It's not like you can't go this route and be perfectly fine. I'm just throwing this info out there so you have a more complete understanding of the typical protocols for melanoma.
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- January 26, 2016 at 7:55 pm
My first question is – does this podiatrist know anything about melanoma?
I have one initial concern. Why isn't he just doing a biopsy – say a punch biopsy? The thing is, let's just say worst case scenario that this is melanoma. If this did happen to be melanoma, you typically would have a biopsy done first. Then if this happened to be a deeper melanoma, you would then schedule a surgery date that would start with a Sentinel Lymph Node Biopsy (SLNB) — this checks for possible spread to the nearest lymph node basin — followed by the Wide Local Excision (WLE). They are done in that order for a reason. The WLE may alter the drainage path making the SLNB inconclusive. Typically, the SLNB is ALWAYS done first before a large chunk of skin is removed — then the WLE. Now, it is possible having the WLE done first will not change the drainage patterns, but no one can know this for certain. If they did the SLNB later, they may find "A" sentinel node, but will it be "THE" sentinel node that would have been found prior to the WLE? No doctor can guarantee this.
I honestly think that the podiatrist — if he truly suspects melanoma — should at least consult with a dermatologist that knows melanoma. Because doing the WLE first raises a red flag for me. If this mole is NOT melanoma or a very thin/early melanoma, then the SLNB would not be indicated and the WLE would be the only course of action. No problem, you just have to heal from the WLE and you are good to go. But as I said, if this was the worst case scenario – a deeper melanoma — then doing the WLE first may compromise staging information.
You need to do what makes you comfortable. I have not had a WLE on my foot but have had several on my legs (one on top of shin bone) and they are very tight and walking – let alone dancing – will take some time. You do not want to split the stitches because that will only mean healing will take much longer. Is he also planning to do other bone related surgery on your foot? I did have bunions cut out years ago on my baby toe where they broke those toes. Honestly, with broken bones healing on my feet, it was a 6 month healing time before I felt comfortable playing tennis – my activity of choice.
Again, I am only really bringing up the worst case scenario and you might choose to think this isn't something you want to think about at this point. That's totally valid. It's not like you can't go this route and be perfectly fine. I'm just throwing this info out there so you have a more complete understanding of the typical protocols for melanoma.
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- January 29, 2016 at 7:05 pm
This has been such a disorienting but swift process. Thanks so much for this email.
The podiatrist was able to do a punch biopsy which goes into the skin versus the shave. He "jumped the gun" by mentioning wide excision and apologized for this because as you mentioned I have not been diagnosed which was upsetting since he was so concerned and wanted to go in right away.
My foot was ithcing last night but I feel OK. My doctor then referred me to a dermatologist. I called their office and they said they can't see me until March 10th and then they called me back to say they could see me on Monday.
I'm waiting for results that they said will get in next week. This is beyond helpful. Now I'm at step 1 – I had the biopsy, waiting for results and seeing what happens next.
I'm glad I came on this forum to ask for some feedback. My podiatrist looked really overwhelmed and busy so I'm hoping that my experience with the derm is different.
Thank you for sharing.
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- January 29, 2016 at 7:05 pm
This has been such a disorienting but swift process. Thanks so much for this email.
The podiatrist was able to do a punch biopsy which goes into the skin versus the shave. He "jumped the gun" by mentioning wide excision and apologized for this because as you mentioned I have not been diagnosed which was upsetting since he was so concerned and wanted to go in right away.
My foot was ithcing last night but I feel OK. My doctor then referred me to a dermatologist. I called their office and they said they can't see me until March 10th and then they called me back to say they could see me on Monday.
I'm waiting for results that they said will get in next week. This is beyond helpful. Now I'm at step 1 – I had the biopsy, waiting for results and seeing what happens next.
I'm glad I came on this forum to ask for some feedback. My podiatrist looked really overwhelmed and busy so I'm hoping that my experience with the derm is different.
Thank you for sharing.
-
- January 29, 2016 at 7:05 pm
This has been such a disorienting but swift process. Thanks so much for this email.
The podiatrist was able to do a punch biopsy which goes into the skin versus the shave. He "jumped the gun" by mentioning wide excision and apologized for this because as you mentioned I have not been diagnosed which was upsetting since he was so concerned and wanted to go in right away.
My foot was ithcing last night but I feel OK. My doctor then referred me to a dermatologist. I called their office and they said they can't see me until March 10th and then they called me back to say they could see me on Monday.
I'm waiting for results that they said will get in next week. This is beyond helpful. Now I'm at step 1 – I had the biopsy, waiting for results and seeing what happens next.
I'm glad I came on this forum to ask for some feedback. My podiatrist looked really overwhelmed and busy so I'm hoping that my experience with the derm is different.
Thank you for sharing.
-
- January 26, 2016 at 7:55 pm
My first question is – does this podiatrist know anything about melanoma?
I have one initial concern. Why isn't he just doing a biopsy – say a punch biopsy? The thing is, let's just say worst case scenario that this is melanoma. If this did happen to be melanoma, you typically would have a biopsy done first. Then if this happened to be a deeper melanoma, you would then schedule a surgery date that would start with a Sentinel Lymph Node Biopsy (SLNB) — this checks for possible spread to the nearest lymph node basin — followed by the Wide Local Excision (WLE). They are done in that order for a reason. The WLE may alter the drainage path making the SLNB inconclusive. Typically, the SLNB is ALWAYS done first before a large chunk of skin is removed — then the WLE. Now, it is possible having the WLE done first will not change the drainage patterns, but no one can know this for certain. If they did the SLNB later, they may find "A" sentinel node, but will it be "THE" sentinel node that would have been found prior to the WLE? No doctor can guarantee this.
I honestly think that the podiatrist — if he truly suspects melanoma — should at least consult with a dermatologist that knows melanoma. Because doing the WLE first raises a red flag for me. If this mole is NOT melanoma or a very thin/early melanoma, then the SLNB would not be indicated and the WLE would be the only course of action. No problem, you just have to heal from the WLE and you are good to go. But as I said, if this was the worst case scenario – a deeper melanoma — then doing the WLE first may compromise staging information.
You need to do what makes you comfortable. I have not had a WLE on my foot but have had several on my legs (one on top of shin bone) and they are very tight and walking – let alone dancing – will take some time. You do not want to split the stitches because that will only mean healing will take much longer. Is he also planning to do other bone related surgery on your foot? I did have bunions cut out years ago on my baby toe where they broke those toes. Honestly, with broken bones healing on my feet, it was a 6 month healing time before I felt comfortable playing tennis – my activity of choice.
Again, I am only really bringing up the worst case scenario and you might choose to think this isn't something you want to think about at this point. That's totally valid. It's not like you can't go this route and be perfectly fine. I'm just throwing this info out there so you have a more complete understanding of the typical protocols for melanoma.
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- January 27, 2016 at 5:13 am
My first question would be, why haven't you been referred to a dermatologist? I am not familiar with podiatrists, I have never seen one, but I would get a second opinion with a dermatologist if I were you. A dermatologist with speciality in melanoma would be even better, if that is available near you. Saying you need a WLE without even having it biopised first is very strange and not the norm. Before you go getting your foot cut into, see a dermatolgist, if you don't even need a WLE it will save you a lot of healing time!
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- January 27, 2016 at 4:57 pm
I didn't say this directly in my reply, but I agree. Have the biopsy instead. Less healing time. Only do the WLE if necessary. Yes, if you need it, you will have to have a separate surgery, but what if you really don't need it? You will be going through significant surgery and healing when you could have got by with just a small biopsy? In fact, I think I would have the biopsy done first in an office visit, wait for the pathology report and then, if needed, have the WLE done at the time of your other foot surgery (wasn't clear if you were having another surgery or not). This also keeps the integrity of the SNB option available in my worst case scenario above.
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- January 27, 2016 at 4:57 pm
I didn't say this directly in my reply, but I agree. Have the biopsy instead. Less healing time. Only do the WLE if necessary. Yes, if you need it, you will have to have a separate surgery, but what if you really don't need it? You will be going through significant surgery and healing when you could have got by with just a small biopsy? In fact, I think I would have the biopsy done first in an office visit, wait for the pathology report and then, if needed, have the WLE done at the time of your other foot surgery (wasn't clear if you were having another surgery or not). This also keeps the integrity of the SNB option available in my worst case scenario above.
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- January 27, 2016 at 4:57 pm
I didn't say this directly in my reply, but I agree. Have the biopsy instead. Less healing time. Only do the WLE if necessary. Yes, if you need it, you will have to have a separate surgery, but what if you really don't need it? You will be going through significant surgery and healing when you could have got by with just a small biopsy? In fact, I think I would have the biopsy done first in an office visit, wait for the pathology report and then, if needed, have the WLE done at the time of your other foot surgery (wasn't clear if you were having another surgery or not). This also keeps the integrity of the SNB option available in my worst case scenario above.
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- January 29, 2016 at 7:06 pm
Thanks, I'm seeing the derm on Monday. I was going to have to wait until March 10th but they had a last minute cancellation on Monday. I'm hoping for the best, and yes, the podiatrist was out of order in his suggestions and I got the punch biopsy on Wed.
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- January 29, 2016 at 7:06 pm
Thanks, I'm seeing the derm on Monday. I was going to have to wait until March 10th but they had a last minute cancellation on Monday. I'm hoping for the best, and yes, the podiatrist was out of order in his suggestions and I got the punch biopsy on Wed.
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- January 29, 2016 at 7:06 pm
Thanks, I'm seeing the derm on Monday. I was going to have to wait until March 10th but they had a last minute cancellation on Monday. I'm hoping for the best, and yes, the podiatrist was out of order in his suggestions and I got the punch biopsy on Wed.
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- January 27, 2016 at 5:13 am
My first question would be, why haven't you been referred to a dermatologist? I am not familiar with podiatrists, I have never seen one, but I would get a second opinion with a dermatologist if I were you. A dermatologist with speciality in melanoma would be even better, if that is available near you. Saying you need a WLE without even having it biopised first is very strange and not the norm. Before you go getting your foot cut into, see a dermatolgist, if you don't even need a WLE it will save you a lot of healing time!
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- January 27, 2016 at 5:13 am
My first question would be, why haven't you been referred to a dermatologist? I am not familiar with podiatrists, I have never seen one, but I would get a second opinion with a dermatologist if I were you. A dermatologist with speciality in melanoma would be even better, if that is available near you. Saying you need a WLE without even having it biopised first is very strange and not the norm. Before you go getting your foot cut into, see a dermatolgist, if you don't even need a WLE it will save you a lot of healing time!
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- January 27, 2016 at 4:44 pm
I was diagnosed with stage 1a melanoma on the top of my left foot in November. I had a wide excision on my foot done by a surgical oncologist at the cancer institute in NJ. He had a plastic surgeon close the wound and was able to close it with the flap method. I went under planning on having a skin graft. Very happy to not have a skin graft. I had the surgery done on January 7. I was able to walk out of the hospital the same day. Thought this is great. Next day I crawled to the bathroom. Couldn't put weight on it. I spent a week in bed with my foot above my heart to keep swelling down. 10 days after had 4 of the 40 stitches out. The rest dissolve. Three weeks after surgery tomorrow I can walk short distances around house without a cane. Long distance need a cane. Foot still swells and hurts by night. I keep it up as much as I can during the day. I go back to plastic surgeon for 4 week post op next Thursday.
Don't know if this helps. BTW I am 46. And use to do classical ballet in my twenties. I have had many surgeries including one on my other foot. So I'm have a high pain tolerance. I NEVER want to do this type of surgery again. I don't know if I had the same thing you are having since mine was already diagnosed with a shaved biopsy at a dermatologist. Who referred me to the cancer hospital. You can email me I can send you photos or give you my cell if you want more information. [email protected]
Cynthia.
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- January 27, 2016 at 4:44 pm
I was diagnosed with stage 1a melanoma on the top of my left foot in November. I had a wide excision on my foot done by a surgical oncologist at the cancer institute in NJ. He had a plastic surgeon close the wound and was able to close it with the flap method. I went under planning on having a skin graft. Very happy to not have a skin graft. I had the surgery done on January 7. I was able to walk out of the hospital the same day. Thought this is great. Next day I crawled to the bathroom. Couldn't put weight on it. I spent a week in bed with my foot above my heart to keep swelling down. 10 days after had 4 of the 40 stitches out. The rest dissolve. Three weeks after surgery tomorrow I can walk short distances around house without a cane. Long distance need a cane. Foot still swells and hurts by night. I keep it up as much as I can during the day. I go back to plastic surgeon for 4 week post op next Thursday.
Don't know if this helps. BTW I am 46. And use to do classical ballet in my twenties. I have had many surgeries including one on my other foot. So I'm have a high pain tolerance. I NEVER want to do this type of surgery again. I don't know if I had the same thing you are having since mine was already diagnosed with a shaved biopsy at a dermatologist. Who referred me to the cancer hospital. You can email me I can send you photos or give you my cell if you want more information. [email protected]
Cynthia.
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- January 29, 2016 at 4:41 pm
Wow, thanks so much for this post Cynthia. I learned a lot from it and it helped better orient me for my appointment.
The podiatrist was able to do a punch biopsy which goes into the skin versus the shave. He "jumped the gun" by mentioning wide excision because I have not been diagnosed. The whole process has been quiete odd and disorienting.
I'm waiting for results that they said will get next week. In the event results come back, WLE is going to be the first step. I have a super high pain tolerance too so I can relate.
In the event that I need a WLE, I will defintely reach out via email. I had a blood clot in my leg a few years back so my doctor explained that I'd have to go on special medication before a procedure.
I get the biopsy done at a hospital that also treats cancer. I struggled a lot in my 20's and wasn't always insured so I'm really hoping for the best since now I have a job and I am insured. I will come back and update you all when the time comes.
Thank you, Cynthia!
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- January 29, 2016 at 4:41 pm
Wow, thanks so much for this post Cynthia. I learned a lot from it and it helped better orient me for my appointment.
The podiatrist was able to do a punch biopsy which goes into the skin versus the shave. He "jumped the gun" by mentioning wide excision because I have not been diagnosed. The whole process has been quiete odd and disorienting.
I'm waiting for results that they said will get next week. In the event results come back, WLE is going to be the first step. I have a super high pain tolerance too so I can relate.
In the event that I need a WLE, I will defintely reach out via email. I had a blood clot in my leg a few years back so my doctor explained that I'd have to go on special medication before a procedure.
I get the biopsy done at a hospital that also treats cancer. I struggled a lot in my 20's and wasn't always insured so I'm really hoping for the best since now I have a job and I am insured. I will come back and update you all when the time comes.
Thank you, Cynthia!
-
- January 29, 2016 at 4:41 pm
Wow, thanks so much for this post Cynthia. I learned a lot from it and it helped better orient me for my appointment.
The podiatrist was able to do a punch biopsy which goes into the skin versus the shave. He "jumped the gun" by mentioning wide excision because I have not been diagnosed. The whole process has been quiete odd and disorienting.
I'm waiting for results that they said will get next week. In the event results come back, WLE is going to be the first step. I have a super high pain tolerance too so I can relate.
In the event that I need a WLE, I will defintely reach out via email. I had a blood clot in my leg a few years back so my doctor explained that I'd have to go on special medication before a procedure.
I get the biopsy done at a hospital that also treats cancer. I struggled a lot in my 20's and wasn't always insured so I'm really hoping for the best since now I have a job and I am insured. I will come back and update you all when the time comes.
Thank you, Cynthia!
-
- January 27, 2016 at 4:44 pm
I was diagnosed with stage 1a melanoma on the top of my left foot in November. I had a wide excision on my foot done by a surgical oncologist at the cancer institute in NJ. He had a plastic surgeon close the wound and was able to close it with the flap method. I went under planning on having a skin graft. Very happy to not have a skin graft. I had the surgery done on January 7. I was able to walk out of the hospital the same day. Thought this is great. Next day I crawled to the bathroom. Couldn't put weight on it. I spent a week in bed with my foot above my heart to keep swelling down. 10 days after had 4 of the 40 stitches out. The rest dissolve. Three weeks after surgery tomorrow I can walk short distances around house without a cane. Long distance need a cane. Foot still swells and hurts by night. I keep it up as much as I can during the day. I go back to plastic surgeon for 4 week post op next Thursday.
Don't know if this helps. BTW I am 46. And use to do classical ballet in my twenties. I have had many surgeries including one on my other foot. So I'm have a high pain tolerance. I NEVER want to do this type of surgery again. I don't know if I had the same thing you are having since mine was already diagnosed with a shaved biopsy at a dermatologist. Who referred me to the cancer hospital. You can email me I can send you photos or give you my cell if you want more information. [email protected]
Cynthia.
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Tagged: cutaneous melanoma
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