Should my Dad (86) with Alzheimer's have surgery on skin cancer melanoma?

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My father is an 86 year old with early stage dementia and Alzheimer's. He continues to decline and most days cannot remember the previous day.

My wife is the primary caregiver and he lives with us in our home.

We are torn with our decision on many different levels and are seeking some advice from others who may have faced similar decisions with the elderly and cancer

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My father has had melanoma removed and now we know that it is in the lymph nodes and he also has dementia , but don't know if he should have surgery to remove the lymph nodes or not, I'm thinking just leave alone , I'm thinking it will make the dementia worse and my mother is the caregiver and it would be harder on her.
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My father had 2 or 3 larger patches of melanoma removed. The dermatologist used a local anesthetic with him and didn't give any follow-up cancer treatment. He was about 85 at the time. As far as we could tell, the cancer did not show up elsewhere in his last years of life.
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Sodaman5, is the mole a small simple mole or a larger one buried deep into the skin? How complex would the surgery be? Out-patient or over-night hospital stay? Would chemo be required or not? There are a lot of different scenarios.

My Dad [93] is always having skin cancer moles removed.... his are done right in the Dermatologist's office, a numbing shot is given in the spot where the mole is located, the mole is dug out, stitches are done, bandaged, and sent home. Nothing else is needed except a follow-up visit. Dad got his skin cancer due to helping his Dad out on the farm in the fields, back in the 1920's and 1930's.
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Does this involve general anesthesia? That can have a profound effect on the brain from which they will never recover. This happened in my Mom's case with uterine cancer 7 years ago, then in early stages of Alzheimer's. She never recovered her mental status as it was before the surgery. Then there is also the question of whether the surgery/anesthesia caused the rapid decline or if family members because of the cancer were just more involved in the care that immediately followed the surgery, only to become uninvolved again within weeks. Consider options carefully knowing that the dementia even without surgery knowing the dementia will only progress.

Another consideration is that cancer in elderly progresses very, very slowly. And ask yourself if Dad would rather live with tge slow decline of dementia that also takes many years and is very difficult for all involved. I have been caring for my Mom for three years now and each day is a bit more difficult for her. If she understood that her brain is slowly dying and her condition is only going to get worse I know she would choose to have her life end. And we now all hope for a stroke, heart attack, or something that will take her faster than the long slow decline of dementia.
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My cousin who is 63 years old with Stage 6, Severe Stage, Alzheimers mixed with Vascular Dementia, recently had a cyst removed from her face. It was done with sedation and not general anesthesia. I made it clear that we wanted to avoid general if at all possible.

It looked terrible, would not heal and was not responding to antibiotics, so something had to be done. She was constantly picking at it. It went very well and it was closed with sutures on the inside, so she was not tempted to pick at it.

As it turns out, it was not cancer. We were quite alarmed, because her mother died from cancer that started out as skin cancer on her face.

Her mother had cancer on her face when she was in her 80's. She was too weak for any treatment, but radiation. That worked quite well, but it came back a year later.. She was too weak for chemo or surgery. She was even too weak for the tests. She did not have dementia. She said she wanted to leave the hospital. She went to rehab at a nursing home and died within 2 weeks. She told me she was ready to go.

I have been reading professional articles about palliative care. It's quite informative. It involves taking each case individually and deciding what would make that patient the most comfortable and cause them the least amount of stress.
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That is true, cwillie. I was assuming that the melanoma was in an earlier stage. I was considering only the surgical removal and not follow-up cancer treatment. That could be considered separately.
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JessieBelle, you assume the surgery would be simple, I know of a much younger woman who lost a considerable amount of tissue on her leg due to melanoma, followed by chemo and radiation. I think I would go with ba8alou's advice and ask the doctor all the tough questions before making a decision.
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Sodaman, I would most like opt to have a melanoma removed from the skin. My only concern would be the anesthesia. Sometimes people with early dementia can be thrown by the anesthesia for a few days. In the early stages of alz, I would consider the benefit of the simple surgery would outweigh the risk. I hope you can stop the melanoma so you don't have to worry about it again.
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I would talk with the surgeon about what is involved in this surgery, both in terms of anesthesia band what recovery will look like. Will he have a dressing that will need to be left undisturbed? Will he be able to comply with that?

If you do nothing, what would the outcome be? How fast does this type of cancer metastisize? What would the doctor do if this were his parent?
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My Dad who is 90 yrs old recently had a recurrence of prostate care. His Dr suggested surgery to stop the surge of hormones to the prostate in hopes of halting any metastasis. I was so scared at having to make this decision as Dad has early late stage Alz.and I make decisions for him. I knew that I didn't want Dad to suffer cancer pain. So he had the operation.. In your case ,as in mine ,we don't know how long they will live. Possibly another 5-10 yrs. do you want to chance having your Dad suffer with cancer pain? If you do decide to have it treated, make sure you work carefully with the Anesthesiologist as to the type of agents they use to knock him out. Some of them make the Alzheimers worse. You can research this on the Alzheimers Assoc. website. Blessings on you and your family.
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