Frail patient for e/o SCC and craniectomy

85-year-old lady for extensive excision of SCC from scalp, transposition flap grafting and craniectomy


  • Severe COPD documented in notes
  • Stable disease for past 2 years
  • Normal spirometry in clinic
  • Walks 1km on flat


  • T4N0MO SCC scalp
  • 45kg, concern regarding frailty and extensive surgical procedure
  • Albumin 42, 4 on Clinical Frailty Scale


  • Patient very keen to proceed with surgery, fully informed of risks
  • Alternative treatment option – radiotherapy, patient feels this would significantly impact on her QoL
  • Surgery is likely to be long and involves craniectomy
  • Increased risk of postoperative pulmonary complications and delirium
  • Consensus is that it is suitable to proceed with planned surgery
  • Disposition – transpositional flap, will have special nurse on ward for observations


  • Proceed with planned surgery
  • ICU 3