Consult: 91-Year-old man for consideration of excision of ear SCC and possible temporal bone flap resection.
- Early Alzheimer’s dementia
- No major cardiorespiratory co-morbidities
- Chronic pain – previous issues with opioid analgesia exacerbating cognitive decline, stable on current regime of Ibuprofen, Paracetamol and PRN Oxycodone
- Mild Alzheimer’s dementia – regular review by geriatrician over the last 4 years.
- MoCA score 20/30. Montreal Cognitive assessment Tool. See www.mocatest.org
- Lives independently with wife in a retirement village, happy with current QoL
- SCC right ear, increasing in size despite previous resection
- Significant risk of both reversible and irreversible cognitive decline.
- Patient and wife understand this risk and are keen to proceed.
- Non-surgical option would be radiotherapy however, patient lives rurally and would have to travel to Port Macquarie every day for treatment.
- Both patient and his wife feel that radiotherapy would be create significant stress to their current lives.
- Untreated SCC is an unpleasant disease with significant pain and lifestyle limitations
- Proceed to surgery as planned