The patient is a 96 yo man with a 6 month history of a tumor on the vertex of the scalp. He has advanced dementia and is taken care of by his 93 yo wife with the help of his three children and some grandchildren. He has insulin dependent diabetes and is on Coumadin and insulin. His diabetes is under good control. The scalp tumor bled a few days ago and his wife took him to the ER where a biopsy was done.
Exam: There is a 4.5 cm tumor on the vertex of the scalp. Small areas of erosion, He has a 9 mm tumor on the right ala nasi. (By history, he picks on the nasal lesion)
Clinical Photos:
Pathology from scalp lesion pending.
Diagnosis: Probable squamous cell carcinoma of the scalp. Nonmelanoma skin cancer nose.
Plan: In this 96 year old man, a palliative approach seems to be indicated. His case will be discussed with a Mohs surgeon and a dermatologist who has a special interest in palliative dermatology.
Reference:
1. De Felice D. Definitive weekly hypofractionated radiotherapy in cutaneous squamous cell carcinoma: response rates and outcomes in elderly patients unfit for surgery. Int J Dermatol. 2021 Nov 24;61(8):911–915. Free Full Text
Our series shows that vulnerable elderly patients with cSCC achieve an optimal response rate (95.7%) with a low toxicity profile after 7‐8 weekly fractions of 8 Gy per fraction with megavoltage electrons. All patients who had developed pain or bleeding before treatment had achieved symptom relief. Only a minority of patients (11.1%) had died of the disease. The efficacy of the hypofractionation RT is therefore of the utmost importance for tumor control and patient quality of life.
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