Should she go to the dermatologist?

mommyandme (m&m)

My mom has a suspicious growth on her back. Originally the hospice doc said, from pictures, that it looked like a cutaneous horn, which is most likely a benign lesion.  Well it’s changed and grown and looks like a melanoma to me.  I’m not a doctor and will have them look again.  My mom has had a few cancerous and pre-cancerous skin lesions removed.  I don’t believe any were melanoma but were the squamous and basal cell type. 

So, should I take her to a dermatologist? I only wonder because if it is cancer what would we do about it anyway? If we wouldn’t be doing treatment why go through the pain of a biopsy? Should we find out to know what we’re dealing with.  Hospice deems her stage 7d. If it is cancer, would dementia or cancer kill her first? Is comfort care the same regardless of the fatal illness? Our hospice nurse’s initial response is not to take her. She’ll look at it again on Friday and talk to the doc if she’s suspicious too. 

I guess I’m wondering what you wise people would do? 

harshedbuzz

m&m--

I'm so sorry you and mom are in this spot. This is purely one person's opinion, but I would not engage a derm unless the lesion was painful to a degree that hospice prescribed pain management would be ineffective. 

If it is some sort of cancer you could be looking at a biopsy in the office followed by an hours long Mohs surgery and months of aftercare.

We continued to treat dad's prostate recurrence which was a decision he made prior ro his diagnosis. This was a twice-yearly injection on the doctor's office intended to prevent the cancer spreading to his bones which would not only be painful it had the potential to cause a pelvic fracture and rob him of ambulation which would impact care options. 

My friend's mom died from breast cancer in stage 7 of Alzheimer's ay home at the age of 93. Her mom had expressed the intention to not screen for or treat cancer after age 80 after having seen 2 sisters fight the disease. This was not an easy path for my friend-- she's a fixer by nature and the physical aspects of untreated breast cancer are tough-- but she was able to honor her mom's wish to not spend her end of life with procedures and chemo.

HB

May flowers

How long ago did the hospice doc look at it? I would probably have the nurse send a new pic to the hospice doctor if it’s spreading, and ask how soon would it become painful. Then make the call. If removing it is a quick procedure for a comfort measure, I would consider it, but if pain can be controlled in other ways (lidocaine patches or something?) I probably wouldn’t. 

I have a similar conundrum with my FIL (stage 7c - ish) he has a good size growth in his mouth, but it is not causing him pain or swallowing issues, so after talking to hospice nurses and his previous dentist (about how fast/slow it could grow) we have decided to let it be. 

M1

I'd let it be M&M.  My partner is not as advanced as your mother and was making six-month derm visits (redhead in the sun all her life), but I have let those go with memory care.  At 7d, even if it is melanoma the dementia is likely to get her first.  And pain management would be the same.  I think hospice is making the right call there.  It is so hard to focus just on the comfort question--but you are right to do so.  And many benign lesions--the "cutaneous horns" that you mention--can look wacky when they get large.

Rescue mom

I have thought about this a lot. My DH, stage 6 Alzheimer’s, had squamous and Basel skin cancers removed regularly for many years. Maybe 25 years ago, he had full-blown melanoma removed from his arm (which his PCP shrugged off for months).

They haven’t found any full cancers in the last few years, and I haven’t even taken him to the derm in a year b/c they *always* found a suspicious pre-cancer to remove “just in case,” and that became really difficult for DH with Alzheimer’s.

Bottom line, unless it’s causing pain, I don’t think I will ever take him back to the derm. Nothing is certain but death and taxes, as they say, but that’s what I think now. If it’s painful, or causing problems, then OK. I definitely don’t want him to be in pain. Otherwise, probably not.

mommyandme (m&m)

Thank you all for your advice and support, sincerely.  The nurse actually came by this morning to take another look at it due to my concerns, awesomely fast.  She took measurements and more pics for the doc.  It’s definitely changed and grown but they still think its a “horn”… gross.  Somehow I can clean her arse and deal with other bodily fluids but this thing makes me gag! YUCK!  Definitely “wacky” as you said, M1.  We’ll use some topical ketoprofen and see what happens.  The dermatologist is out, no need to create discomfort by all that’s required to just be seen by a doctor, let alone a procedure. 

Thanks again! So glad I’m not alone!