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Dad is 93, kinda frail/ailing, and currently on Eliquis (among others) for a leg clot. They found a squamous cell on his ear and want to arrange Mohs. Having had several Mohs myself, I know how easy OR hard it can be (e.g. 1/3 of my face removed once). I don't want to make his decision for him (he is inclined not to, which I understand totally) but having a tough time helping him decide which way. Any ideas? I am torn on this. Thank you! (oh, I should mention, that he is already depressed about being so old, pretty immobile, and constant medical and failing heart issues... cute as heck tho :)

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I watched this play out in my mom's nursing home. There was a man who had a growth on his ear and a decision was made to watch and wait. But the cancer began to grow rapidly to the extent that the ear and whole side of his face became swollen and for "reasons" nothing was done for several months (I was dismayed and questioned the staff and of course they could tell me nothing other than his family was aware). In the end most of his ear was removed (they left enough so he could still wear his glasses) and he seemed to recover well. So my advice is to take care of a small problem before it becomes a bigger problem. They should know how to work around his need for blood thinners - my BIL has had Mohs several times and is on coumadin
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Depending on his life expectancy , skipping this procedure may make more sense than going through with it .

Personally , I’d lean towards agreeing with him to skip it .
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swmckeown76 Jun 25, 2025
At 93, he could easily live another 7-10 years unless he develops other serious problems. Does he really want to die of cancer?
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Does he understand the implications of having the Mohs surgery or not having it? Does he understand that not having the surgery could shorten his life? If he's competent to make the decision to have or not have the surgery, it's his decision and not anyone else's. Also, is he on medication for depression if he's been diagnosed with clinical depression? If not, his taking the proper medication might change his outlook and he'll want the surgery....or it might not.
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Speak honestly with the doctors, because this skin cancer is very unlikely to be the thing that kills an elder of this age, and well may be a bad idea overall. I would ask for a great deal of honesty in the discussion.
I know that the docs must understand about the Eliquis. Because this surgury cannot be done on someone taking a clot inhibitor; bleeding would be pretty bad I would think. Eliquis, unlike predaxa, cannot be quickly or easily reversed, and in that way dangerous for certain; so discuss that with doctors, as well.
I wish you good luck in this decision.
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"Squamous cell carcinoma (SCC) can be dangerous if not treated, but it's often highly treatable when caught early. While most SCCs are curable with early treatment, particularly if they are small and haven't spread, advanced or untreated SCC can be disfiguring, dangerous, and even deadly."

If this is small, I would have it done. I have had basal cell done so I know what is involved. It will be removed and a bandage put on it probably.
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Thank you all for your very thoughtful comments. It's much appreciated and helpful. I do, also, feel it's totally his decision and because he rarely understands what a dr. tells him, I usually am the one to have to articulate pros and cons clearly and loudly (he's way hearing impaired and hates wearing aids--or keeps losing them :) ) several times (and perhaps many) ways. I will let you all know how it goes and what is final decision will be. Luck to you all, take care of yourselves... and thanks again. Ruth
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A resident at mom's AL was about 93 when his kids convinced him to surgically treat skin cancer on his face, which he followed up with chemo of course. Half of his face was removed, causing horrible trauma to the poor man, and the chemo finished him off in a painful and horrible fashion. His funeral was very sad and his children were very sorry they'd talked him into such a foolish decision. The lobby was quiet from then on, as this lovely resident used to play the piano there daily before the "simple" treatment for cancer began.

Had an in-situ cancerous melanoma mole NOT been removed from my arm, I strongly believe I would not have stage 4 cancer today.

My mother was 93 when a cancer was found on her chin. The dermatologist was hired to remove an annoying wart on her finger that was bugging her for years. When they called me strongly suggesting they treat the chin cancer, I told them absolutely 100% NO. Mom died 2 years later of advanced dementia and CHF.
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If it's not too advanced, a topical chemotherapy might work. 5-Fluorouracil is approved for actinic keratoses and SCC, especially in situations where surgery isn't appropriate.

Topical 5% 5-fluorouracil versus procedural modalities for squamous cell carcinoma in situ and superficial basal cell carcinoma: A retrospective cohort analysis.
Holly Neale, BSa ∙ Melissa Michelon, MDb ∙ Susan Jacob, MDa ∙ et. al.

The topical chemotherapeutic agent 5-fluorouracil (5-FU) is commonly used to treat squamous cell carcinoma in situ (SCCIS) and superficial basal cell carcinoma (sBCC). For patients who wish to avoid procedures or are not good surgical candidates, 5-FU may be a preferred treatment option. It is less expensive than some procedures and other topicals (ie, imiquimod). The reported success rates of 5-FU for SCCIS and sBCC range from 27% to 90%. Additional investigation is needed to understand whether topical 5-FU, under real-world conditions, has comparable treatment success to procedures for epidermally-limited keratinocyte carcinomas.
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