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

Background:

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

Issues

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

Discussion

• 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

Plan:

• Proceed with planned surgery
• ICU 3