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

NO !!

Don’t do this to her. She’s 90. Lewy body dementia is a terrible disease. She can’t recover. Now she has cancer. She may not understand what you’re doing to her with an operation and she’ll die soon anyway. Palliative care is a good thing and you should discuss it with those who provide it. Hospice lets them pass with the support and love of the hospice community. I went through this with my dad. He had lymphoma and had a mass removed from his colon shortly after lymphoma diagnosis at 92. He was never the same after that operation and I wish he hadn’t done it. His choice. Our problem because his dying took a long time, all my energy, and caused him too much suffering. Just let your mom go. It’s time.

Too late for palliative care.
My own wife of 58 years of marriage died Feb. 5th, 2022. I am very empathetic, understand pretty well what you will be going through.

You need to go on the internet and download the DURABLE POWER OF ATTORNEY FORM, so next of kin can make arrangements with doctors, banks, healthcare decisions and end of life decisions for the ill person.
If the ill person is too sick to sign the form, you must go to his/her two doctors to confirm health disability; also two witnesses to your signature for her, in place of hers, in front of a Notary.
We called Vitas Healthcare and put her in Hospice Care at home. I just went through this same agony. Wife 82 died after 1 year of pain and misery, agony. Even in Hospice care for that year, she couldn’t talk, couldn’t move, had pain, but we couldn’t assess just how bad it was.
Your first priority should be getting her pain under control. Hospice nurses promptly respond to your questions. She’ll probably have to be sedated, because any serious diseases goes through stages, Able to walk, able to sit up, able to roll over… with assistance, then immobile. Bedsores become an everyday occurrence, treatable to a degree only. They won’t heal.
My wife suffered so much. Wasn’t able to eat or drink, even with baby bottles. We had her on 1 mL (liquid Morphine) every four hours, orally in cheek or under tongue till she passed. There were a couple of other meds given just to keep her comfortable.

1st thing: Immediately get the Notarized Durable Power of Attorney done. Don’t delay! It will make things tougher.
Call a Hospice Healthcare. Your choice. Get recommendation from Hospital; patient’s current health insurance will auto-terminate when Hospice starts. Hospice supplies most of the equipment and moves it in for you. Full electric bed, bed table, diapers, etc.
If you need guidance and helpful suggestions, message me.

Freezing it off would be the Least invasive. Anesthesia is Known to be bad for people with dementia . Forget a skin Graft - I had to have them and they take quite sometime to heal - several Months and if that area gets infected you can Lose the graft and Have to be regrafted or your body rejects the graft . Hospice sounds Like a Great idea . Also there are topical solutions that are Holistic . I would try that first . Grafts Take a lot of work to keep clean .

I was a dermatology medical assistant for 22 years. I have seen what putting such
an elderly, infirm patient through a skin cancer treatment does. Don't agree to the surgery, it is too much, and VERY stressful for them. (skin grafts, open wounds,
bleeding) Make her as comfortable and happy in her time left. End of life care is
very advanced, dignified and the kindest you can do for her.

God Bless You for being such a loving child.

famfinder: Depending on the location of the skin cancer on the body, perhaps she can opt for MOHS surgery. Best wishes.

I would explore treating with local radiation with a radiation oncologist. Most are associated with hospitals. It is only local radiation so usually not affect her well being. It would mean quick painless trips to get the radiation. That quickly a growing cancer can become a real mess unless treated, and uncomfortable also..

Please look into this as a non-evasive treatment.

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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.

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!

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.

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

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?

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.

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.

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.

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?

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.

Have you had her evaluated for hospice?

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

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.

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

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

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

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'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.

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.

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.

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

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,

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.