My dad is 93 and has recurring squamous cell skin cancer on his scalp that has gone into his skull. Should he have surgery?

If it were me, I'd ask what happens if we don't do the surgery. I am extremely grateful that I am not having to make this decision, and I feel for you. Please let us know how you get on with further discussions.

There are many treatment options available, depending on the size of the lesion, and how invasive it has become.

Talk to your Dad's Dermatologist, as treatment can be as simple as Cryotherapy, electodessication, excission, topical chemotherapy or laser, more likely MOHS surgery that is usually done in the Dermatologists office under local anesthetic and the most widely used treatment option, to the more extensive excision with skin graph or mesh closures. Chemotherapy and radiation therapy would be necessary for extensive, invasive lesions, so it would be up to the Dermatologist to determine how to go about treatment, with the best possible outcome for cure and good healing, but how your Dad would do with the particular treatment, would be dependant on his age, his health, and his physical ability to handle the possible anesthesia necessary to treat it.

It's a big decision, that needs to be discussed at length, to make the most informed decision, and every patient and every situation is different. My guess, that at 93, the least invasive treatment would be best, if only to control the spread of the lesions.

Ask the doc what he would do if it was his father. Some other points to ponder:
If the cancer has spread to the bone I expect it is pretty advanced, would there need to be treatment beyond the surgery?
How much time would he need to be under anesthesia?
If we choose no surgery are there other options?
How quickly might it spread, and how painful is it likely to be?
and
Does your father want to do the surgery?

Loss of memory is a very real concern with anesthesia in the very elderly--along with just the dangers of being very old and just not doing well with anesthesia in general.

Does your dad still have the capacity to make his own medical decisions? If so, you have to let him do what he chooses. My FIL was actively dying from leukemia and wanted a skin cancer removed from his forehead. The derm dr was shocked that he wanted aggressive treatment. But he had the surgery. It healed about the time he died.

If you are making his medical decisions. then I would talk to the Dr and ask about weighing out the long term vs short term benefits. I wasn't in charge of FIL, and I would never have OKed a surgery like he had.

That sounds like a brutal surgery and a not pleasant recovery. At some point in our lives, we all have to decide how much "more" we're willing to do. 93? He's had a good long life.

Best wishes-whatever you decide.

Like said, its his decision but the doctor must tell him the pros and cons. If I had to make the decision, I would say no. They will probably want to do chemo or radiation and do you want Dad to go thru that. Once in the bone very hard to cure,

Thank you all for your advice. Dad is mentally fine, and making his own decisions. He wants to have the surgery because, as he puts it he doesn't like the alternative. He has already had MOHs in office for the first lesion. This second one is worse, and he is going to a head and neck surgeon. They are doing all kinds of pre clearance testing to ensure he can be okay after the anesthesia, but i still think it's a risk.

Is the plan that he will be completely out under general anesthesia for the surgery? If so, is there any alternate to that? Please just be aware that it’s sometimes very hard for the elderly to rebound mentally from general anesthesia, and if they do it may take months to get back to baseline, so patience is needed. My mom (but who already had mild dementia) never did get back.