As a grandmother and former special education teacher, Ulema Hirsch is no stranger to challenges. In fact, she's beaten breast cancer and basal cell carcinomas before. But this time, it was different.
"I've had some cancers,” she says. “But none of them have been serious like this one.”
The melanoma on Hirsch’s forehead needed to be treated with surgery. That meant removing a lot of skin — enough to change her appearance quite a bit.
“I had a hole in my forehead the size of a baseball,” she says.
She would need reconstructive surgery to get back to life as she knew it. That’s where Michael Eggerstedt, MD, a facial plastic surgeon at Rush, came in.
From Fortune 500 to forehead reconstruction
By the time she was diagnosed with melanoma, Hirsch was no stranger to getting news that changed her life plans.
Able to speak several languages, she dreamed of working as a U.N. interpreter when she was young. But her plans changed when Gen. Douglas MacArthur, who led the United Nations Command in the Korean War, wrote her a letter telling her the role wasn’t open to women.
She also wanted to become a mother, so she adopted a daughter. To her surprise, Hirsch was pregnant five months later.
She planned to continue working at a Fortune 500 company using her language skills to communicate with international associates.
But adoption rules at the time forbade women who adopted children from working. So, her plans changed again when she had to leave her job.
Once her children were in school, she found a calling in special education and had a rewarding career. She is now retired and enjoys caring for her grandchildren.
When Hirsch developed breast cancer, she was lucky to have only a small lump removed, rather than her entire breast.
Later on, she developed basal cell carcinoma on her shoulder and underneath her eye. Even though these usually aren’t life-threatening cancers, they needed to be removed with surgery.
So when she needed care for melanoma, which can be very life-threatening, she had already been through treatments like chemotherapy and surgery before.
But this time, she had a whole team of doctors at Rush in her corner, including Eggerstedt.
The plan to fix the hole
“At our melanoma tumor board, we discussed her case between the radiation doctors, medical oncologists, dermatologists, her head and neck surgeon and myself, the reconstructive surgeon,” Eggerstedt says.
Together, these specialists formed a treatment plan for Hirsch. It involved removing a large portion of skin from her forehead and scalp, followed directly by reconstructive surgery with Eggerstedt.
“The treatment left her with a 7-centimeter defect — just about the same size as a baseball — on her right forehead and up under her scalp down to the bone,” Eggerstedt says.
That defect needed a special approach to restore not only the skin that had been removed, but her hairline. It would involve several techniques, so Eggerstedt used a staged reconstruction.
“I basically laid the groundwork for reconstruction by moving her hair-bearing scalp forward so that she wouldn't have missing hair at the hairline,” Eggerstedt says.
He then placed a temporary “scaffolding” over the lesion. “It's called a skin substitute,” Eggerstedt says. “And then I allowed this to seal in for a couple weeks. After that, I came back and did a skin graft that I laid over her forehead.”
This staged approach would make sure that Hirsch would have a natural hairline and a smooth surface on her forehead instead of a depressed area.
Where does the new skin come from?
To perform a skin graft, Eggerstedt needed to take a small portion of skin from somewhere else on her body. And to make sure that it blended in, it would have to come from somewhere that looked like the skin on her forehead.
“It was funny,” Hirsch says. “He asked, ‘Where do you think the skin is coming from?’ And I said, ‘I've been asking everybody. They say your butt.’ And he started laughing.’”
Eggerstedt explained that the skin would need to come from somewhere that had seen more sunlight to appear natural.
He selected a small patch under Hirsch’s chin, which would heal with time. "I selected this site for the skin graft because it would give her a slight neck lift as a bonus," Eggerstedt says.
Once the skin from the donor site was grafted to her forehead, it just needed to be, as Hirsch puts it, “sanded down.”
“I did three in-office episodes of dermabrasion afterwards to smooth out any scars,” Eggerstedt says. “And now she has an excellent result.”
Hirsch says that friends and family who saw pictures of her forehead after the initial surgery are impressed.
“Now they see what he's done, and they just can't believe what it looks like,” she says. “He has done an excellent job. I mean, there are many doctors who are nice, but he goes above and beyond the call of duty.”
In fact, Hirsch put off moving out of state so she could continue her treatment with Eggerstedt.
“Right now, I have a plastic surgeon who has done so much for me," Hirsch says. “He's not only my doctor, not only a professional, he's like my friend. Each time I go in, he's concerned how I feel. If I don't understand something, he reiterates it and makes sure that I know exactly what's going to happen. He's been with me from the beginning. Why would I want to move to a state where I have somebody who doesn't know squat about me?”
What her grandchildren — and the rest of us — can learn
Now that she's healed from the surgery, Hirsch hopes it’s a challenge her grandchildren can learn from and avoid.
Hirsch’s doctors explained that her skin cancer most likely came from sun damage that had gone on for years. As a teen, she worked as a lifeguard, and throughout her life, she spent a lot of time sunbathing.
Her daughter-in-law isn't letting her kids follow in grandma’s footsteps into the sun.
“Her girls get so much cream on them before they go swimming in the pool,” Hirsch says. “It’s zinc oxide all over, from one end to the other. And they always ask, ‘Mom, why do you put so much on us?’ and she says, ‘Well, Nana's had her fill. It's not going to happen to you.’”
Eggerstedt also has advice for anyone who might need reconstructive surgery following a procedure like Hirsch had. He says patients should seek treatment from a care team made up of specialists from many fields, including facial plastic surgeons.
“The tumor board at Rush has dermatologists, Mohs surgeons, radiation oncologists, medical oncologists, head and neck surgeons and reconstructive surgeons. Everyone meets in-person and discusses these cases,” Eggerstedt says. “It's been shown that these discussions improve outcomes for skin cancers as well as cancers overall.”
You can learn more about Rush’s reconstruction options on our Facial Plastic and Reconstruction Services page. And if you’d like to schedule a consultation or get a second opinion, you can call Rush at (888) 352-7874.
