Consult: 91-Year-old man for consideration of excision of ear SCC and possible temporal bone flap resection.

Background

• 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

Issues

• 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

Discussion

• 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

Plan

• Proceed to surgery as planned