Melanoma of scalp diagnosis in my 86 year old mother with dementia. Any insight? - AgingCare.com

Melanoma of scalp diagnosis in my 86 year old mother with dementia. Any insight?

Follow
Share

My mother is 86 years old and in around stage 5 dementia, still recognizes people but losing walking ability and thought processes quickly. She was diagnosed with brain atrophy on MRI this past summer, no mention of anything else seen. I was just told by a dermatologist this week that he highly expects a skin biopsy about the size of a dime from her scalp to come back as melanoma. We had pointed it out to various docs who just ignored it. Though understanding the severe treatment of melanoma, and her advanced dementia, she has no desire for melanoma or cancer treatment per se. Just wondering if treatment towards recovery is not chosen, what are the next steps or tests required, if any, and what is a life expectancy for this if not treated? I can only find such information regarding full treatment, excision, grafting and chemo, but not what we're looking at if left alone. Derm said not to tell her as skin cancer was always a huge anxiety for her and he's known her for years. Week prior she was saying she just wanted to die without even knowing this complication, and has already refused invasive treatment for hydrocephalus shunts and doesn't even want to be put on insulin injections. She's just done with life she says. Still waiting to hear back from pathology on what happens next. Does anyone have any familiarity with how melanoma progresses without treatment? Having had a MIL go through the full spectrum and terror of dementia, perhaps this will be easier for her than later progression of dementia to not knowing us or where she is and being a complete panic case with her lifetime anxiety issues. Truly don't know what to think or what's next. Thank you for any insight.

This question has been closed for answers. Ask a New Question.
11

Answers

Show:
So happy her diagnosis was more positive with the suspected melanoma. I would get another opinion, but at this state just enjoy being with her on Thanksgiving and love her for the time she has left. My best to you...
Helpful Answer (0)
Report

I agree with Veronica. Also, part of the beauty of having hospice is being able to spend the patients' last days, weeks or months, whatever, focusing on a celebration of their life. A what of medical treatment, especially for cancer, leave the patients feeling sickly, tired and not wanting to participate in activities. It's not a great way to spend one's final days on earth.
Helpful Answer (2)
Report

SoCalGirl. You know your Mom is at the end of her life from whatever cause. I don't know if she actually wants to die or just not continue living. Either way she is at peace with her decision. There is no point in second guessing any diagnosis at this point. Try and enjoy whatever time you have left with her and support her decisions. Hospice will make sure that she is comfortable so do not worry about Ferris's prediction of her death being difficult. Even if it is Melanoma and it is an aggressive disease in younger people cancer typically progresses more slowly in the elderly. Older people frequently have multiple skin cancers removed from their skin and are merely treated with a kind of chemo ointment. As this has not even been suggested and the nurse told you the entire lesion was removed do not waste these six weeks worrying when you may have little time left with your mother. Could someone help your mother with the phone. As she gets weaker she may have trouble holding the phone and getting it up to her ear. A six week follow up appointment after any procedure is routine. The Dr just wants to check that the wound has healed properly and reassure the patient that all is well with this wound. If the hospice nurse says the wound is fine and Mom does not want to make the trip there will be no harm in calling the Dr and telling him she is too weak to make the trip. Talk this over with Mom's hospice RN and the social worker, they will be able to ease your anxieties and give you a better idea of how your mother is progressing.
Helpful Answer (2)
Report

Melanoma is the deadliest of skin cancers, and if she does not want to have chemo and wants to remain ignorant of the diagnosis, then when it spreads to other parts of her body, she will die. Since she recognizes family she can't be this at the stage you mentioned, however, since she refused a shunt and insulin, she clearly wants to die. If you have POA or knew her wishes before she had dementia, do as she wished. Not an easy way to go...
Helpful Answer (0)
Report

SoCalGal, my dad had horrible, awful moles on his back. I'd look at them and think, OMG, they're cancer for sure. Black ones, ones that would bleed, ones with different colors, etc. All of the things that looked just like the pictures on the internet. The doc would look at his back (his regular family physician) and would say, "Nope, they're all OK". So sometimes things that look bad to us as laypeople are really not bad. Glad to hear you got good news on your mom!!
Helpful Answer (1)
Report

Thank you all for such great responses! Since then, I have received a call from her derm's nurse who says she's fine, they got it all, see you in six weeks for a wound check. which completely contradicts everything the doctor suspected. So now I'm not sure if the doctor, knowing no treatment is requested, has just said that until he sees us in six weeks for further discussion, or somehow this huge black spot that looks just like the melanoma pics was nothing. Either way doesn't change the treatment plan, but still has me highly questioning this latest diagnosis. Yes, she is also getting very close to being unable to walk and falling often, does use a walker and has a call button if she falls. She is in a very nice assisted living facility which provides hospice care, but the guessing games of her stages are always changing it seems. This week's frustration is that she no longer seems to understand us on the phone, my only form of communication between visits as I live out of town. She does okay with in-person conversation but the phone is tough for her to follow any conversation and she just gives up and says goodbye. Looking forward to spending Thanksgiving today with her and family.
Helpful Answer (1)
Report

Hospice can come to your house to give their services, you don't have to have your mother move out. We were told that all hospice needed was a cancer, dementia, or other terminal disease diagnosis to put her on their palliative care service.

Hospice will make sure that she is never in pain. That is what we all worry about! Their specially trained nurses/aides can see through the dementia to determine if the person is in pain or not. We were told that dementia blocks the ability of a person to actually remember that they hurt - that is why UTIs take off so quickly in them - they don't report symptoms. I don't know when my mthr is hurting, so I really need someone else to figure her out and keep her pain free!

I'm suspicious that your other docs knew this was melanoma, and did not think it should be treated. Every doc knows what to look for... You have to die from something, and dementia/Alzheimers seems like an undignified way to die from my perspective. Complications from cancer, though it sounds scary, sound better to me than being completely dependent on others for care and a long, drawn out death from dementia when you don't even understand what is happening to you.

Dying Well by Byock helped me come to terms with this whole idea of choice in dying. I highly recommend the book for all who will be part of this decision. GB!
Helpful Answer (1)
Report

I would call in hospice people and get their opinion to see whether mom is a candidate for their care. She sounds like a woman who still knows what she wants and it's palliative care and not treatment. I agree with CarolLynn and PStiegman. And at her age, the Alzheimers will probably be more important than the melanoma, which spreads more slowly given her age.
Helpful Answer (1)
Report

I absolutely agree with both the above. Don't tell her and do not do anymore tests or treatment. Hospice would be appropriate but don't push it if you are managing and it would just cause her more anxiety at this time.
We were told by N/H staff when my MIL with dementia stopped walking that her life expectancy would be expected to be no longer than six months from their experience. They were correct.
Helpful Answer (2)
Report

It seems as if your mom has been firmly grounded in the belief of not wanting invasive medical intervention and she continues to age. If you know this to be true, then her choices are not out of dementia or depression and you should consider allowing her the dignity of letting nature take its course. If melanoma is caught very early, they're can sometimes be a successful outcome. However you've indicated you've been pointing it out for a while, so if it is melanoma, you haven't caught it early. The biggest problem with melanoma is that it often metastasizes BEFORE excision and biopsy, and depending if they find cancer cells in the margins, they want to do more aggressive tissue removal and chemo. If your mom won't accept brain shunt surgery or diabetic treatment, IMO she would hardly want aggressive cancer therapy.
Helpful Answer (2)
Report

This question has been closed for answers. Ask a New Question.
Related
Questions