Mom (90) with LBD has skin cancer. Do we operate?

This is a difficult decision for you… truly I feel that man’s medicine often gets in the way of God’s plans…

I use to work as a physical therapy aide in a hospital. Needed to get a 90 year old women up out of her chair. I recall vividly how the women kept saying she wanted to just die. She had a pacemaker placed the year before…I wondered how that impacted the rest of her life…

All depends on the type of skin cancer. Melanoma is a killer, but other forms of skin cancer are localized, slowly invasive and curable if removed promptly.

My FIL, actively dying from CLL (a type of leukemia) had a skin cancer removed from his forehead just 8 weeks before he died. I took him to the derm dr who asked how aggressively he wanted to treat this. Dad replied "OH, very aggressive!" Dr keeps looking at me and finally I said "I am his DIL, not his daughter. I have zero say in this".

Dad had the surgery and was buried 8 weeks later with stitches still in his forehead. Yes, the skin cancer may have eventually taken his life, but the 25 year battle with leukemia was the cause.

I had to go to his house 3xs a day to clean and dress that wound, along with the ones he had where he had fallen and scraped the papery skin off his forearm and shoulder.

I admired his spunk and will to live, but couldn't wrap my brain around his terrifying fear of dying. He went tanning the week before he died. A 72 yo man going to a tanning booth. That's hopeful!

Fam, did the doctor give you any idea of the prognosis?

Obviously this is fast, whatever it is but, if post operation care isn't possible because mom can't comply, what happens?

What happens if she can't keep her hands off it?

I would wait for the labs. I have seen to many people that had skin cancer and it led to one surgery after another until death. Never adding anything to the quality of life for the patient, just one sore that wouldn't heal because ALL the cancer couldn't be removed.

That's what I would want to know, because you already know that the anesthesia is going to adversely effect her. So what are the REAL chances of getting everything and this being a one time surgery.

I would never let anyone cut on my loved ones without proper testing.

I am sorry you are having to face this type of decision. Life gets to a point when there are no choices, only options, especially with dementia.

You will do what is best for your mom and that is all you can expect from yourself.

I may do the surgery. But if found the cancer has spread thru her body, I would not do chemo and would call in hospice. I would not do rehab if she has Dementia. In Home can send a wound care nurse to her MC.

MC is not skilled nursing. CNAs are not medically trained. Yes, they can report to the RN that a growth has popped up but as you said, this was very fast.

https://www.agingcare.com/topics/91/palliative-care

Here is a link for this forum that explains palliative care.
Wishing you and mom the best course of action.

I think your best idea is to ask your Mom's own MD for a consult with a palliative care MD. There is also a lot online.
For a cancer of the skin which would need grafting I am not certain I would do this. Much depends on the options you should discuss with the MD. Is there a possibility of open and close that is less aesthetically pleasing but would get rid of the lesion. Is the lesion open. Is it rapidly spreading. What kind of cancer is this. Is Mom aware and would she prefer hospice care dependent on prognosis or would she want palliative or other care.
Yes, anesthesia is a REAL concern.
Speak openly with the MDs. And with Mom if she is able. And then make best decision you can. I sure wish you luck.

A man that lived in my mother's ALF named Marty had skin cancer on his nose that he wanted removed when he was about 90-some odd years old. He did not have dementia, never mind stage 6 LBD. He used to play the piano in the lobby of the ALF and entertain the residents, that's how sharp he was. He had surgery on his nose, and the treatments were SO debilitating, his sons were crying when they told me it was THE worst mistake they'd ever made on his behalf, ever in their lives. Marty died during the cancer treatments, and his sons buried him with that regret laying heavy on their hearts. In reality, they thought they were doing 'the right thing' for their dad, and I felt so sorry for them that they had such guilt.

If this were my mother who had advanced dementia as she did at 95, I'd leave her alone and give her no treatment at all. She, in fact, did have squamous cell cancer on her chin and also on her face (upper cheek) that the dermatologist kept warning me NEEDED to be removed. I finally told the dermatologist to stop visiting mom in the Memory Care after they'd removed the wart on her hand that was bothering her.

Mom passed on Tuesday of other causes, not from skin cancer.

The decision is up to you, of course, but consider the quality of her life NOW, with stage 6 dementia at play, and how life would be after a surgery, anesthesia, and rehab, then make your decision accordingly. My condolences over this entire situation and that you're both in such a position to begin with. Sending you a hug and a prayer for peace, whatever you decide to do.

Uplate from the OP:
"So. Doc is mum until labs come back. He is calling it squamous cell, BUT. IT HAS tripled in size in 5 weeks time. ? I am beginning to see it is about how we feel when we die... not when we die. or how. It is about the emotional memory we want to create for our loved one".

So, about 2 years before her death, mom had a rapidly growing neoplasm on her face. She'd had melanoma before and wanted that thing gone.

The dermatologist who visited her NH facility gave us some choices.. Mohs surgery, or a punch biopsy. We opted for the punch biopsy in his office with local anesthesia.

Once they'd looked at the cells, it was a squamous cell cancer. From there the choice was Mohs surgery to get the rest, do nothing or a chemo topical cream to get what was at the margins. We opted for the cream.

Man, that thing REALLY looked like melanoma. Even to the docs. Don't panic before you need to,

Two years ago, we tried to convince (we had no legal way to stop her) our LO that she didn't need skin growth removal and biopsy at age 86 as she would die of the dementia and old age before she will die of cancer. She insisted it was melanoma and was too painful to not have it removed. Even after the removal and biopsy, she insisted that it was melanoma when it wasn't. It was BCC - the mildest form of skin cancer. From then to now she constantly complains the surgery made the spot twinge/itch/hurt/on-and-on and asks how to get her money back from the doctor as it "isn't what I wanted". Our LO admits she is afraid to die; even with her LBD insists she never will because "I don't want to die".

Do what you think is best. If it was my decision, I lean toward having it frozen to slow the growth but skip the full-on surgery.

Here is some good info to answer your question: How to Find Palliative Care (webmd.com) https://www.webmd.com/palliative-care/how-to-find-palliative-care

It really depends on if the cancer has spread to other organs in her body. If the cancer only involves skin in that 1 area, get the surgery. If the cancer has spread to multiple organs, go for palliative care and hospice.

Former hospice nurse - choosing non surgical treatment may be less likely to cause complications, or to require anesthesia/surgical wound/need for skilled nursing care in a rehab setting. ALF and MC do not do wound care or monitor healing.
The dermatologist can order skilled home health care for wound management of the lesion, and that team may come up with a dressing that only needs changing 2x/week, with a goal of teaching family how to do wound care.
Hospice can provide wound care and other supports as she approaches the end of her long life. Help with bathing, some supplies in addition to wound care supplies. medications related to her hospice qualifying diagnosis, and education and support for her and for you and your family. Hospice does not cause death, but provides some comfort and support to families to reduce your regrets after she is gone.
A squamous cell lesion can grow rapidly and look very nasty at her age. And the likelihood of a skin graft site healing in this situation is very very very low.
Her primary care provider is the one to refer to hospice, I imagine the dermatologist would consider that out of his/her sphere of practice.

I'm no expert on the subject of skin cancer, but if the grafting is for cosmetic reasons, I'd tell the doc that we aren't entering any beauty pageants and to skip that step.

Ask the skin care doctor the very questions you asked her and make sure he understands your mom's other medical issue. He can explain how the skin cancer unfolds if left untreated or may explain better to you the limits she would have if you do treat.

I am an RN. I work on a geriatric medical psych unit. If she was my Mom I would do hospice. Of course it’s a personal decision that you have to make. God Bless

My husband also has Lewy Body. He has been with Hospice for a year now. Definitely the best choice. They do everything to keep the pain controlled and the patient calm along with helping the caregiver. At 90 to do surgery seems to only prolong the agony, then again she may pass during surgery, which with Lewy Body may be a blessing 😞 I know to many that may sound cruel, but Lewy Body is the cruelest disease of all, no mercy for your LO

We knew my Mom's wishes...no life extending measures. When they told us at 92 that she needed a pacemaker she said no and we said no. The Dr is trained to treat. Your job is to assess quality of life. The procedure and follow up will likely be painful. Our hospice was wonderful. It was a year ago and we could finally be in the same room as my mother for the last 48 hours of her life

The anesthesia will have a negative effect on her already diseased brain. Being bedridden and not walking post surgery will be the next downfall.

If she were my mom I would not do surgery but start with hospice. What were your mom's wishes before her LBD?

Hospice will be able to keep her comfortable.

Our bodies were not meant to last forever and start to break down.

Have you had her evaluated for hospice?

Squamous cell may not qualify her as it is easily treated.

There are some squamous-related lesions that grow rapidly but are often self-limiting and not likely to grow forever. (Keratacanthoma). A skin graft, esp on lower leg or foot does require an extended period of no weight bearing. I did exactly that myself last summer. I am otherwise mobile and was physically able to make adjustments, but every normal activity of the day was an "athletic event.". Explore the option of open healing if you decide to do the surgery. An open wound takes longer to heal and requires careful management, but might be a better choice.

All I can tell you, it is your decision. If it were a parent of mine, in my mind, there would be no doubt. Surgeons love to do surgery, and doctors sometimes they over look the human factor. This is why I would go hospice. She is 90. She has been in memory care for 4 years, so I am guessing she might not understand the pain, the whole process, and would be very upset and scared. I would let her go, with pain control and hospice. I don't now where you live, but my brother died in April, in Springfield IL. I was his guardian for 40 years although he lived in a residential community, and had severe CP since birth. He was diagnosed with colon cancer and lung cancer and was 80. I called hospice right away as he would never understand what was going on and be terrified. He died 3 weeks later with great gentle care. I don't know the whole story with your Mom, but with what facts you have mentioned, and if she is not able to give you input, if it were my Mom, I would look into hospice. A very hard decision, I know. Does she have a living will?

If it were my mom, I would try to get her on hospice and not put her through the surgery which will only worsen her LBD. Skin grafts, wound care, rehab...that is a lot.

Palliative Care - Hospice can make her comfortable for the time she has left. That seems like the more humane / kinder direction to take.

What am I missing in regards to having surgery for a malignant skin cancer? My mother had invasive squamous cell skin cancer and each tumor (like 15 tumors or more) was treated by MOH’s surgery. Perhaps you mom can be given a mild sedative before this surgery, so the doctor can complete the MOH’s procedure? It can be stitched up and wound care would be easier. My daughter had melanoma and she had a MOH’s.

My mother’s skin cancer eventually spread throughout her body, But this took years in the making.

Anyway, I would ask about MOH’s and see where this takes you. If this is not a workable way to go, then Hospice will know when to attend to your Mom. Wishing you the best in your journey. I was my mom’s caregiver for 10 yrs.

I would strongly consider letting the surgery happen to prevent this lesion from impacting her quality of life.

Immediately afterwards, start her in hospice. Don’t follow up with systemic cancer drugs.

Personal opinion....
I would opt NOT to do the surgery.
I would contact Hospice.
(She qualifies either way just due to the LBD)
The question right now is the lesion causing pain or discomfort? If it is not then I would leave well enough alone.
With surgery there is a good possibility that
1. recovery from anesthesia will be difficult
2. She will not return to her current "baseline" cognition after.
3. She will not understand what is going on and may pick at the new enlarge wound.
4. Since she is probably not very active blood flow is often reduced that will effect the healing of the wound. That may or may not heal at all.
5. If rehab is required will she be able to participate?

Did the doctor give a "prognosis", an expected outcome if she has surgery VS not having it? What is her lifespan with and without surgery?
Will she have to have follow up treatment? Chemo or radiation? If yes to either is this something that she could tolerate? And would you put her through it for what result?

We were in a simular position. My father wasn't a candidate for Moh's surgery. His cancer was growing.

I did some research and found a product called CuraDerm Bec5 from a doctor in Vanuatu. I bought it from Ebay of all places, it wasn't on Amazon at that time. I put a little bit on my father's squamous cell cancer several times a day. I kept it cool in the refrigerator. I also found an interesting natural website that had good ideas. I went to the farmer's market and bought an eggplant. I cut it up and let it soak in apple cider vinegar for five days before I threw out the eggplant. I kept the liquid cool in the fridge. I used a cotton ball to put this on his cancer site first, let it dry before I put on the Curaderm Bec5. – Vanessa RN

You might also consider the stage. If it is at a stage where it has metastasized (spread to other areas, internal organs etc.), the prognosis could be poor. And once the surgical removal of the visible area is completed, besides wound care, would there need to be other treatment, i.e. chemotherapy, radiation therapy ? These are all questions I would ask. And I think it would help your decision how to proceed.

I’m doubtful surgery would add to quality of life vs just increasing quantity. However, the necrotic tissue sounds horrible & could cause infection or sepsis, as well as being a hygiene problem ( pain, smell). For her stage of LBD — medical procedures could be terrifying to her. And that stress could decrease her level of function. It’s never easy making these decisions! Some Surgeons like to cut regardless of quality of life. You need a full picture of what progression of her skin cancer would look like without treatment. Wishing you all the best at this challenging time!

Many types of skin cancer are not life-threatening and they can be removed through a rather superficial surgery. I would go for the surgery. The benefits will be greater than the risks. If it were a melanoma with metastasis, I would go directly to hospice.

Please look into this as a non-evasive treatment.

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