Agresive bcc in ear canal women age 83

@bluemax1972: I can appreciate your reaching out here at Mayo Clinic Connect to try to understand the situation your mother is facing with the recurrent BCC. As mentors and others who have experienced similar conditions, we cannot give specific medical advice, but perhaps we can assist in answering your question, for which the most precise answer would best be handled by the provider who is overseeing your mother's care.

Mapping in itself is actually considered a part of the Mohs procedure during which the provider who is performing the surgery is careful to mark or deliniate the area in which the skin is removed and then sent for microscopic examination to check for cancer cells. In the event of positive margins - or cancer cells - the provider can then go back to the exact location that was so identified, or "mapped", in order to remove additional tissue. The process is repeated until no cancerous tissue is detected. To my understanding, Mohs surgery cannot identify the gene structure or mutation that may be causing the cancer. Personally, I underwent separate genetic testing when I had been diagnosed with metastatic melanoma but as far as I know this is generally performed for such more advanced cancers; it may be done for SCC or perhaps such cases as advanced BCC. This would need to be discussed with a medical provider.

There are various reasons that can contribute to recurrent BCC, which in mother's case does appear to be the underlying subtype of the more rapid growth that spread into deeper tissue. Biologics are often considered when surgery is not an option or has failed and/or individuals who have experienced issues with poor healing - which can be impacted by older age, poorer circulation, comorbidities (meanting other medical conditions such as diabetes), a weakened immune system or a diet deficient in certain vitamins. All these considerations may have led to the recommendation of biological drugs.

Does this information help provide a basis for more detailed conversation with your mother's doctor?

Thanks for your answer, the oncologist who examined my mother recommended a protocol that includes giving ODOMZO/ERIVEDGE as first-line drugs with a warning about possible serious side effects. Interestingly, each of the drugs is intended for different types of BCC, which brings back the question of the importance of identifying the type of BCC ( mBCC or laBCC ) and how to identify it, anyway thanks.

@bluemax1972: Your mother is lucky to have you assisting with her care as you're clearly staying on top of her options. While it's unusual for BCC to become so advanced, as you're unfortunately seeing, it is possible for it to be locally advanced (laBCC) where the cancer has gone deeper even into bone or metastatic (mBCC) where some of the original cells have spread to more distant organs. Ways to look for this include biopsy, CT or MRI imaging. As you noted, the medications you listed are indicated for treatment for advanced BCC. As with all treatments, risk vs. benefit is worthy to consider when taking such meds.

These fact sheets provide an overview on each of the medications in their generic names: Odomzo https://www.mayoclinic.org/drugs-supplements/vismodegib-oral-route/description/drg-20075421 and Erivedge https://www.mayoclinic.org/drugs-supplements/vismodegib-oral-route/description/drg-20075421

Can you let me know how she does with this treatment?

Hi, my mother is recovering from a difficult ear surgery, 3/4 of her ear and parts of the ear canal were removed and the surgery was stopped after it was understood that the tumor was aggressive and had spread deep into important structures and there was no reason to cause her any further suffering and a transition to a different treatment protocol that was not surgery was needed. At this stage we are waiting for recovery from the surgery for the area to stabilize before starting a course of medication in order to locate the tumor as a touchstone for the success of the drug treatment. Starting drug treatment without the ability to measure success is irrelevant and not right for the patient.