Advanced Basal Cell Carcinoma in a Patient With Schizoaffective Disorder

Abstract

The approach used by the authors for managing a patient with a schizoaffective disorder and advanced basal cell carcinoma involving the eyelids, orbit, and face is presented. Complexities included the advanced nature of the disease, neglect of the patient's condition due to schizoaffective disorder, the difficulty of obtaining informed consent, the required aggressive surgical intervention, reconstruction, and the necessary management during the postsurgical period. A multidisciplinary team approach with psychiatry, ophthalmology, ear, nose, and throat, plastic surgery, radiation oncology, oncology, legal, and bioethics specialties is required in patients with cognitive disabilities. Curative treatment requires complete excision, reconstruction, and proper postoperative care, which can be prohibitive in a schizophrenic patient from a surgical and ethical perspective. Staging of this condition after proper informed consent with biopsy, computed tomography, and magnetic resonance imaging is presented. The options for management are discussed, including surgical intervention and palliative care.

Clinical time course of the neglected giant sebaceous gland carcinoma

“…Declining surgical treatment can cause irreversible damage, especially in elderly patients with poor compliance [5][6][7][8][9][10]. Increased risk of mental diseases, including dementia and schizophrenia with advanced age, can diminish the patient's compliance [5,6,8,9]. There are few cases with basal cell or squamous cell carcinoma who refused surgical treatment in the literature [5,6,8,9].…”

“…Sebaceous gland carcinoma is a rare malignant tumor of the eyelid, comprising 1% to 5.5% of all eyelid tumors [1][2][3][4]. Postponing and neglecting treatment, especially in the elderly patients with low compliance, can lead to poor clinical outcomes [5][6][7][8][9]. To the best of the authors' knowledge, there is no study in literature that presents the progression of a sebaceous gland carcinoma with clinical photographs.…”

End-of-life care in schizophrenia: a systematic review

“…In another case, a 63-year-old homeless woman with schizoaffective disorder was brought to the emergency room by law enforcement and found to have ulcerated and infected facial lesions determined to be advanced basal cell carcinoma (Taylor et al, 2013). Because she was actively psychotic and refusing treatment, a temporary legal conservatorship allowed diagnostic evaluations to be completed.…”

“…Because she was actively psychotic and refusing treatment, a temporary legal conservatorship allowed diagnostic evaluations to be completed. Due to the advanced stage of cancer and rapid disease progression, she was determined not to be a candidate for surgical treatment and instead received palliative care, pain management, and proper wound care (Taylor et al, 2013). Obtaining temporary conservatorship in this situation was appropriate and led to establishing a diagnosis and prognosis which informed the subsequent treatment plan.…”

“…Palliative care can help substitute decision-makers and healthcare providers by assisting with making critical decisions about treatment, which is illustrated in the aforementioned cases of individuals with chronic kidney disease and comorbid schizophrenia requiring dialysis (Kadri et al, 2014;Rice et al, 2012). Furthermore, the utility of palliative approaches is highlighted in the several case reports about individuals with schizophrenia and comorbid cancer (Moini and Levenson, 2009;Riquin et al, 2017;Taylor et al, 2013;Terpstra et al, 2014;Tylec et al, 2018;Weiner, 2011;Weir, 2014;Wright et al, 2013). A common theme is the diagnosis of cancer at late stages with limited treatment options complicated by active psychotic symptoms and impaired decisional capacities with treatment refusal and aggressive interventions at the end of life.…”