Frail patient with fungating tumour, severe cardiac disease

PIG Meeting: 25th February 2021

79yo nursing home resident with an invasive, fungating BCC or SCC on his leg.


  • Cardiac disease
    • PPM for AF/CHB
    • Admitted with CCF last year – found to have PHTN with TR and RV failure.
    • Improved, discharged to NH
  • T2DM diet controlled
  • RA
  • CKD
  • Low exercise tolerance 3.6METS on DASI


  • Profound SOB
    • Rpt TTE – relatively unchanged, mild improvement
  • Anaemia
    • Hb 117 -> 83, ? Cause. Nil obvious bleeding.
    • Likely contributing to his SOB


  • Should he have surgery?
    • Overall life expectancy appears short
    • Surgeon, family and patient all keen to proceed
    • Essentially palliative surgery for pain/symptom relief
  • Opportunities for optimisation?
    • Cardiologist r/v suggests HF reasonably controlled
    • PRBC transfusion (likely as part of surgical admission due to logistic challenges with patients in NH)
  • Anaesthetic technique?
    • Skin grafting required so SAB likely ideal. Care with haemodynamic given pulmonary hypertension.