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My father has had this small pimple-like spot biopsied, frozen, cut, etc. 4 times since February. This last time, it was diagnosed as cancer. How was it not 3 previous times? Well, in one month it has gone from the size of a nickel to a crater about 4 inches across. Growing rapidly, weeping constantly, very painful. I can't cover it because of the size and because he's developed an adhesive allergy. Plastic Surgery said it's too large to remove in office (it was about 2 inches across when they said that) and he will need surgery with general anesthesia a minimum of 2 hours while they check margins and create a skin graft. He is still mobile, engaged with family, an avid reader, pretty easy to care for in spite of AD. This, I never saw coming. It needs treatment because it is so painful and is causing him distress to see in the mirror. Anyone know other treatments we could try? I really want to avoid general anesthesia. They said sedation was not an option. Has anyone else experienced this? His overall health is good.

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This is a tough call mainly because you said it is causing him pain. And it is distressing for him.
If the doctors think he will get through the surgery alright that is half the battle.
Do know that he will probably decline due to the anesthesia. It is not a "death sentence" but you never know how much the anesthesia will effect him. He may be fine, it may take a week to get back to "baseline" or a month or he may not return to his pre surgery cognition.
So as much as I am normally for minimizing medical procedures I think in this case I would opt for the surgery.
Recovery will be difficult mainly because he is going to want to not keep his hands off the area. And it will look worse before it gets better and that may upset him as well.
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Reply to Grandma1954
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Given that he seems to be in the very early stages of dementia and is therefore many years away from dying from Alzheimer's I would go for the surgery if that is the only/best option given, especially since this is causing symptoms that are negatively affecting his QOL now and into the immediate future.
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Reply to cwillie
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You need to decide on the presence of value and quality of life. Clearly pain is a symptom that needs to be treated to continue quality of life. You do not mention his level of dementia. For dressings, you will need to speak to a wound specialist who will know about types of dressings that are out there.
You probably should go with the surgery knowing that there may be some delerium and decline. In his case his pain needs to be taken care of. Hope for the best!
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Reply to MACinCT
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The cancer is painful and distressing: that alone will cause your father's health to decline, including his mental health.

So, yes, anaesthesia will likely cause some progression of his dementia, but treatment would bring him some relief.

There is always a risk of death when undergoing anaesthesia, even for a young and healthy person. In my early 40s, I stopped breathing during surgery and was at risk of not waking up. The alternative to surgery was becoming paralyzed. The risk was worth it.
There is risk with so many things in life; they can't all be avoided.

If it were my decision to make, I would opt for my parent to have the surgery and have a chance of being comfortable in their last years. There is no comfort or peace to be had with a painful, weeping cancerous wound.
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Reply to MiaMoor
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Anxietynacy Jul 7, 2024
I was thinking the same thing, and also I would definitely shut down and talk of chemo or radiation, really quick.
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"Although squamous cell carcinoma can be more aggressive than basal cell cancer, the risk of this type of cancer spreading is low—as long as the cancer is treated early...the lesions must be treated with respect because they may grow rapidly and invade deeply."

Source: https://www.yalemedicine.org/conditions/squamous-cell-carcinoma#:~:text=Although%20squamous%20cell%20carcinoma%20can,grow%20rapidly%20and%20invade%20deeply.

You don't say where the lesion is, but sounds like it may be on his face. Close to his brain and lymph nodes? Has any of his doctors checked to see if it has spread? If not, why not? If so and it's only that lesion, then there may be other treatment options.

Options include:
Excisional surgery.
Mohs surgery.
Cryosurgery.
Curettage and electrodesiccation (electrosurgery)
Laser surgery.
Radiation.
Photodynamic therapy (PDT)
Topical medications.

"In June 2020, pembrolizumab (Keytruda®) was approved by the FDA for the treatment of recurrent or metastatic SCC that is not curable by radiation or surgery. In July 2021, the FDA expanded this approval to include SCC that is locally advanced and not curable by radiation or surgery."

Source: https://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma/advanced-scc/#:~:text=Treatment%20overview&text=In%20June%202020%2C%20pembrolizumab%20(Keytruda,curable%20by%20radiation%20or%20surgery.
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Grandma1954 Jul 2, 2024
A friend of mine, her husband has LBD / Parkinson's and he was put on Keytruda for a skin cancer. Made the dementia much worse they discontinued the Keytruda. May be an isolated incident but it would be something that I would look into.
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My cousin aged 69 got it on his nose. It got huge he had it removed but did nothing else, he died 4+ years later from it, did ok until the very end. He had mild dementia.
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Reply to MeDolly
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My 80-year father had a two-hour double hernia surgery under general anesthesia. He has dementia and was even more confused for a solid week after surgery, but it had to be done because he put the surgery off for over five years due to his wife being ill and dying. He was in a lot of physical pain. We were very concerned with general anesthesia too, but dad recovered well considering the dementia symptoms.
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Reply to Joyful13
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I'm 87--much older than OP's parents if I read the profile correctly. I would probably opt for the surgery to deal with the pain and disfigurement. Both of these would be a real drag on quality of (remaining) life--for me. At my age I likely would not agree to chemo or radiation due to the side effects. If I were 60-something, however, I might make a different decision. I would definitely inquire about palliative care and hospice.
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Reply to ElizabethAR37
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Do the surgery. Your Dad is still reading. He has very, very early dementia.
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Geaton777 Jul 11, 2024
My 100-yr old Aunt with advanced dementia could read anything and everything but she wasn't processing the words. The ability to read does not mean there's a higher level of cognition in operation.
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Have you gotten a second opinion? Sometimes you will find specialists have differing opinions on treatment and or experience with AD patients that might help you with this decision.
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