My mother (91) has stage 5/6 Alzheimer's and has melanoma on her cheek. Should we opt for surgery?

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She was diagnosed with melanoma in situ last May and was scheduled for MOHS surgery in August. After our pre-op meeting with the surgeon, he found that it had grown. He said that he would have to cut from her ear to her nose, then do a skin graft from her chest. The surgery would require her to be completely under anaethesia, and would take a long time. Recovery would be traumatic also. He said alternative was the imiquimod topical cream which may or may not get all of the cancer. We have a follow up appointment on Oct 3rd. This is after treating the melanoma for about 5 weeks with the imiquimod. This cream is causing the skin to break down, bleed, and she says it burns. I cover the raw skin with a protective coating of vaseline then apply the imiquimod to only the perimeters. Then I bandage it because she picks at it. Her skin has always been sensitive. I am so torn as to what to do from here. I am her sole caregiver, she lives with me so it is a 24/7 job. My brother and I share both medical and legal power of attorney. My brother lives three hours away, and is busy with his job and life so very very rarely does he come for a visit. My instinct tells me that her quality of life is the most important thing. I do not know if the treatment cream is working, but will find out more in a couple of weeks. I also agree with the surgeon, who after meeting with us for a very long time before the scheduled surgery, told me that he did not think she would be able to tolerate either the surgery or the recovery because of her advanced stage of Alzheimers. He also said that if it were HIS mother, that he would not have the surgery. I just want to do the right thing for my sweet mother! Please help ... any and all advice are more than welcome as I feel so very alone in this. thank you ...

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Thank you all so very much for taking the time to answer! I do have some helpful information now, thanks to all of you. I will be asking the dr about alternative therapies, and if they are also too invasive,I will not be putting my mother through any more misery and confusion than she is already dealing with. Thank you all again for your thoughtful insight.
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PJB, you've received some insightful, helpful and compassionate answers, to which I can only add that although I don't have first hand experience with melanoma, a relative does and has gone through agony with repeated topical treatments. Despite that, the lesions continue to appear.

This is not a trauma which I would ask anyone to endure.

Yours is a difficult decision; I think at this point, after asking the questions you need to, ask your what you think would be the least invasive, uncomfortable, agonizing and traumatic for your mother, especially factoring in the Alzheimer's stage.

I would go with no surgery if there are no other alternatives as Stacey suggests. This is a difficult choice you face, determining which is the "lesser of 2 evils."
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My mother had some type of cancer above her ear. We chose not to do anything. Anesthesia could very possibly make the dementia worse and it would be more trauma and pain for her that we were not willing to expose her to.
My grandmom who was 93 lost circulation in her foot, the only solution was to amputate. After 3 agonizing weeks (before the next doc appt) my grandmom said that she lived a good life and didn't want to spend her final days in the hospital and in pain. She was if sound mind and able to make the decision herself but sadly, i whole heartedly agreed. Praying for some peace and comfort for you and your mom 🙏.
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Oh gosh, tough call! I work in the surgery (mohs) to remove those types of facial cancers as a surgical tech, and my understanding is that there are other options like, Superficial Radio Frequency Therapy (SRT), and Photodynamic Therapy (PDT) being used these days, however these would need to be discussed with her Dr, depending on the size, severity and location. It sounds like she will need to be asleep and under anesthesia, as extensive reconstructive skin graft repairs for an aesthetically pleasing result on the face will need to be done by a plastic surgeon, and anesthesia is always a worry in the elderly.

I would ask her Dr if these are possible options, and also, how fast the Melanoma is likely to spread, or become systemic? I do know that those topical Chemotherapy treatments can be brutal, especially on the thin and tender skin of an elderly person, Ouchy!

I would definitely pose your question in the form of, What would you do if this was your Mom?

The only other thing I can say is that these cancers do spread and can become invasive, so sometimes there are no other options but to treat them. I wish you well with your course of treatment!
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I'm so very sorry that you are in the position of having to make this decision.

I've gotten into the habit, over the past several years, of asking docs what they would do if this were their mom. I usually get the same answer you do. I would proceed with comfort care, and Hospice when needed. Again, so very sorry.
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I'm so sorry you're faced with this situation and decisions. My first thought was that this just sounds like torture for your mom. 91 years is an amazing life, she's earned not being tormented by medical procedures that sound so cruel. I'd be asking the doctor for meds and whatever else to make very sure she's comfortable and call a halt to anymore intervention on this. She probably can't understand the situation and is simply tired. I hope you both find the kind of rest you each need soon. Blessings to you
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