Wide Local Excision (WLE)
Wide Local Excision (WLE)
Wide local excision means removing more skin around the scar of your melanoma removal.
This is performed to reduce the risk of melanoma return but also helps in staging.
WLE is at times combined with other procedures such as SLNB (LINK TO SLNB PAGE) and/or reconstruction.
The amount of skin removed depends on the thickness of the initial melanoma but is either 1cm or 2cm.
This procedure is usually performed under local anaesthetic but for certain body parts, a general anaesthetic is preferred.
The remaining defect can be closed in several ways (see below), all appropriate in certain circumstances:
Dressings:
Certain wounds may not be appropriate to reconstruct and may therefore be dressed until they heal.
Pros: Quicker operation, avoids extra wounds, daycase
Cons: Longer healing time, needs regular dressings changes
Skin substitute:
May be appropriate especially in scalp wounds
Pros: allows the body to rebuild tissue within the biodegradable skin substitute, improves skin quality, daycase
Cons: expensive, requires two operations 3-4 weeks apart, can fail
Split-skin graft
A partial shaving of skin is sutured to the wound. The donor site where the graft is taken from heals with dressings in 2-3 weeks.
Pros: less failure risk, simple to perform, usually daycase
Cons: poorer cosmetic result, more scar contracture, two open wounds, limitations on movement for a week.
Full skin graft:
The full thickness of the skin is used, instead of a partial shaving.
Pros: looks better, less contraction, donor site can be stitched together, daycase
Cons: less reliable, only for small wounds, limitations on movement for a week
Local flap:
More complex way of closing wounds by rearranging surrounding skin.
Pros: best cosmetic outcome, more reliable than skin graft, faster healing, can be done awake, usually daycase
Cons: longer scar, may require revision surgery
Free flap:
A transplant of skin and fat from another part of the body.
Pros: allows most wounds to be closed, quicker healing at times, reliable
Cons: general anaesthetic, hospital stay, failure, further surgery
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