Mom (90) with LBD has skin cancer. Do we operate?

I am an RN. I work on a geriatric medical psych unit. If she was my Mom I would do hospice. Of course it’s a personal decision that you have to make. God Bless

Former hospice nurse - choosing non surgical treatment may be less likely to cause complications, or to require anesthesia/surgical wound/need for skilled nursing care in a rehab setting. ALF and MC do not do wound care or monitor healing.
The dermatologist can order skilled home health care for wound management of the lesion, and that team may come up with a dressing that only needs changing 2x/week, with a goal of teaching family how to do wound care.
Hospice can provide wound care and other supports as she approaches the end of her long life. Help with bathing, some supplies in addition to wound care supplies. medications related to her hospice qualifying diagnosis, and education and support for her and for you and your family. Hospice does not cause death, but provides some comfort and support to families to reduce your regrets after she is gone.
A squamous cell lesion can grow rapidly and look very nasty at her age. And the likelihood of a skin graft site healing in this situation is very very very low.
Her primary care provider is the one to refer to hospice, I imagine the dermatologist would consider that out of his/her sphere of practice.

All I can tell you, it is your decision. If it were a parent of mine, in my mind, there would be no doubt. Surgeons love to do surgery, and doctors sometimes they over look the human factor. This is why I would go hospice. She is 90. She has been in memory care for 4 years, so I am guessing she might not understand the pain, the whole process, and would be very upset and scared. I would let her go, with pain control and hospice. I don't now where you live, but my brother died in April, in Springfield IL. I was his guardian for 40 years although he lived in a residential community, and had severe CP since birth. He was diagnosed with colon cancer and lung cancer and was 80. I called hospice right away as he would never understand what was going on and be terrified. He died 3 weeks later with great gentle care. I don't know the whole story with your Mom, but with what facts you have mentioned, and if she is not able to give you input, if it were my Mom, I would look into hospice. A very hard decision, I know. Does she have a living will?

A man that lived in my mother's ALF named Marty had skin cancer on his nose that he wanted removed when he was about 90-some odd years old. He did not have dementia, never mind stage 6 LBD. He used to play the piano in the lobby of the ALF and entertain the residents, that's how sharp he was. He had surgery on his nose, and the treatments were SO debilitating, his sons were crying when they told me it was THE worst mistake they'd ever made on his behalf, ever in their lives. Marty died during the cancer treatments, and his sons buried him with that regret laying heavy on their hearts. In reality, they thought they were doing 'the right thing' for their dad, and I felt so sorry for them that they had such guilt.

If this were my mother who had advanced dementia as she did at 95, I'd leave her alone and give her no treatment at all. She, in fact, did have squamous cell cancer on her chin and also on her face (upper cheek) that the dermatologist kept warning me NEEDED to be removed. I finally told the dermatologist to stop visiting mom in the Memory Care after they'd removed the wart on her hand that was bothering her.

Mom passed on Tuesday of other causes, not from skin cancer.

The decision is up to you, of course, but consider the quality of her life NOW, with stage 6 dementia at play, and how life would be after a surgery, anesthesia, and rehab, then make your decision accordingly. My condolences over this entire situation and that you're both in such a position to begin with. Sending you a hug and a prayer for peace, whatever you decide to do.

Uplate from the OP:
"So. Doc is mum until labs come back. He is calling it squamous cell, BUT. IT HAS tripled in size in 5 weeks time. ? I am beginning to see it is about how we feel when we die... not when we die. or how. It is about the emotional memory we want to create for our loved one".

So, about 2 years before her death, mom had a rapidly growing neoplasm on her face. She'd had melanoma before and wanted that thing gone.

The dermatologist who visited her NH facility gave us some choices.. Mohs surgery, or a punch biopsy. We opted for the punch biopsy in his office with local anesthesia.

Once they'd looked at the cells, it was a squamous cell cancer. From there the choice was Mohs surgery to get the rest, do nothing or a chemo topical cream to get what was at the margins. We opted for the cream.

Man, that thing REALLY looked like melanoma. Even to the docs. Don't panic before you need to,

Ask the skin care doctor the very questions you asked her and make sure he understands your mom's other medical issue. He can explain how the skin cancer unfolds if left untreated or may explain better to you the limits she would have if you do treat.

I was a dermatology medical assistant for 22 years. I have seen what putting such
an elderly, infirm patient through a skin cancer treatment does. Don't agree to the surgery, it is too much, and VERY stressful for them. (skin grafts, open wounds,
bleeding) Make her as comfortable and happy in her time left. End of life care is
very advanced, dignified and the kindest you can do for her.

God Bless You for being such a loving child.

This is a difficult decision for you… truly I feel that man’s medicine often gets in the way of God’s plans…

I use to work as a physical therapy aide in a hospital. Needed to get a 90 year old women up out of her chair. I recall vividly how the women kept saying she wanted to just die. She had a pacemaker placed the year before…I wondered how that impacted the rest of her life…

Fam, did the doctor give you any idea of the prognosis?

Obviously this is fast, whatever it is but, if post operation care isn't possible because mom can't comply, what happens?

What happens if she can't keep her hands off it?

I would wait for the labs. I have seen to many people that had skin cancer and it led to one surgery after another until death. Never adding anything to the quality of life for the patient, just one sore that wouldn't heal because ALL the cancer couldn't be removed.

That's what I would want to know, because you already know that the anesthesia is going to adversely effect her. So what are the REAL chances of getting everything and this being a one time surgery.

I would never let anyone cut on my loved ones without proper testing.

I am sorry you are having to face this type of decision. Life gets to a point when there are no choices, only options, especially with dementia.

You will do what is best for your mom and that is all you can expect from yourself.

It really depends on if the cancer has spread to other organs in her body. If the cancer only involves skin in that 1 area, get the surgery. If the cancer has spread to multiple organs, go for palliative care and hospice.