Friday, July 24, 2009

Dad's skin cancers

Wanting to catch everyone up with regards to Dad's skin cancers.

At the initial visit with the new dermatologist (Justine attended with me), Dr. Iwasaki immediately identified 3 spots of concern on Dad's face. As previously mentioned, the 1st two were tested to be a melanoma and a squamous cell on his upper left cheek and forehead respectively. Dad was referred to a specialist and these cancers were successfully removed. The melanoma was considered "in citu" meaning that it had not spread. The 3rd spot around the fold of his mouth next to his cheek was identified as a basal cell. Dad had his appointment with Dr. Iwasaki this past Monday to have it removed in the office. It turned out that the cancer was quite deep, and in fact the doctor told me today that they were not able to get to all of it at the appointment on Monday. She was going to recommend referring him to the specialist to try and remove the remainder.

I raised my concern about the importance of continuing to have Dad subjected to these surgeries (certainly doesn't like all the needles in his face and he is usually quite tired the 1st few days following the surgery). Dr. Iwasaki mentioned that a basal cell rarely will metasticize, so that depending upon how much longer we expect Dad to live, it would not likely kill him. She did mention that it could possibly move to his gum, and perhaps cause some pain, but not necessarily. We also talked about the fact that she had previously recommended that after these initial 3 surgeries, Dad should have a full-body inventory. We have to split it up into two appointment (above waist, below waist), and I have scheduled the 1st appt for Monday, August 3rd. My thinking is it would be good to understand how much more we might be looking at having to address, before we make any decisions about proceeding with another surgery. Specifically, I think it would be beneficial to know if there are any more melanomas, or squamous cells, which have a greater potential to metasticize in the blood stream and adversely affect Dad's end of life.

Dr. Iwasaki also suggested bringing up the question of Dad's life expectancy with the doctor (he has an appointment next week) and to get his input on the necessity of the surgeries. It would be nice to have Dr. Lichstein's input on this since he knows so much more about Dad...did he ever offer and thoughts on Dad's life expectancy?

Everyone's input on this matter is greatly appreciated.

1 comment:

Justine said...

I realize that it is probably really impossible to have a proper conversation with Dad about this - but it would be nice to try. Maybe when he's in one of his more 'coherent' stages and conversational. I just really wish I knew more about what he himself would feel. We all know he has regularly made comments about 'just dying' and sometimes when I have asked him about what he wants or thinks - he just laughs!

I think it will be difficult to get an assessment on life expectancy, but certainly we can ask. I had the impression from Lichstein that he is in generally good condition with a few issues that are manageable (like high blood pressure). I will be curious to get the impression of the new doctor.

I assume we might want to have some discussions together at the beach about this as well.

Justine