Please help. Just found this on my dad's back.

[sprigatito]

My dad's partner died of cancer a few days ago, he and I were with her when she died, and I've brought him home with me until the funeral (and probably permanently). He's got Alzheimer's and his partner was his carer. He's been looking pained and twisting his shoulder, he said it's just a spot, but I made him show me his back and found this. It looks just like the squamous cell carcinoma he's had removed before, only it's enormous. He's lost weight and is pale and more vague and breathless than usual, but I thought it was just grief

This is really fucking bad, isn't it? He survived stage 4 lymphoma in 2017 and has a heart condition. I have a doctor calling me back from 111, but should I just take him to A&E?

Sorry, it's bh weekend. UTC/minor injuries or 111 it definitely needs looking at before derm opa.

Hi OP, the skin on your dad's back looks like it's necrotising. If A&E is completely out of the question I would definitely try and get a face to face GP appointment as soon as you possibly can.

With the same caveat as before that I’m not a medic - in the original pics in your OP I was concerned there was ulceration.

Your further pics and fresh concerns confirm this so - imo there is no alternative but to take him to A&E to get it assessed.

You won’t get a GP appt on a weekend and they will just send you to A&E. It needs dressing.

The op may be near an UTC or minor injuries. Or 111 can signpost her to a nurse practitioner or gp out of hours appointment.

Op, I'd advise against A&E you'll wait hours and it will be very stressful for your df.

She might be, but my local minor injuries wouldn’t drain an infected cyst - they sent me to A&E; neither do they operate OOOs - you have to book an appt.

I'm calling 111 now but my hopes aren't high. The night I posted this thread I waited all night for a doctor to call back and they never called. My worry with A&E is that it's Friday night and he won't be seen as urgent, he's in his 80s and not robust 😞

I'll be ripped to shreds for saying this but I'd milk it a bit and say he's been delirious/dizzy etc and go to A&E. if it is the worst case scenario then at his age, every second counts

In my area, calling 111 will get you an appointment with an OOH, especially if you mention the ulceration and pain.

The second photo- I’m hesitant to say because I’m not in anyway medically trained but- it looks like a lot like a dilated pore of weiner which is a very minor non issue.

So that need not add to your worries too much.

Just checked the app, waiting time at our A&E is 10 hours. No minor injuries unit. It's either A&E tonight or a walk in centre tomorrow.

I had to take my 86 year old dad to A&E about 8 weeks ago and it was fine. He’s frail, confused etc. We didn’t have to wait that long either.

OOH service is only via 111, I'm currently trying to get through.

An OOH appt would be great if you can get one

I've just taken his temperature and that was fine, so I'm a bit reassured by that. It needs cleaning and dressing at the very least though, and I don't think I should do that myself. I wish it wasn't so hard to get medical attention when you need it 😫

I have nothing useful to add; just a hug and a handhold.

On Tuesday morning I would phone your GP and say that he possibly has an infection. I would also phone the dermatologist that said they couldn't see him until June and tell them (or send pictures if you can). Changing quickly is a symptom of cancer. While, of course it doesn't mean it is, if something goes from "it could be cancer because any little mole, lump or blemish could be cancer" to "it is behaving rather like cancer in the rate it's changing", dermatology should take note. I wouldn't go to A+E unless he needs something for pain or open wounds. A+E priority is to do with symptoms right now, and right now it isn't an emergency even if it is cancer.

If he's ok in himself as you say no temp, it isn't oozing or bleeding etc I'd wait for walk in centre am if 111 can't offer an appointment this evening. All A&E will do is have you waiting until 4am and stick a dressing on you'll all be exhausted. It can wait imo. I think his rest and wellbeing is as important at this stage.
Obviously up to you though.

If it’s a fungating tumour it’s not that likely to turn into a systemic infection despite bacterial activity (does it smell?) but it still needs dressing. In fact it could be mistaken for an abscess if you don’t give his lymphoma/skin cancer history.

I haven't noticed a smell, there is a stain of blood and fluid on his shirt though. It's much darker than it was a few days ago, and bigger. I'll be there at any medical appointments and will make sure they have the full history.

I know you’ll be with your dad, like I’ll be with mine.

Technically you don’t know what it is tho, which is in your favour in trying to get an appt asap, as a large abscess would need to be seen immediately.

Hope you're ok, OP. I've been thinking about you & your Dad (for strength)

That is a very good point (and I am very slow on the uptake!)

If I see the waiting time at A&E drop significantly, I'll take him in.

Honestly, this looks a lot like the squamous cell carcinoma my aunt had. I described it as a greyish volcano. They removed it all very quickly - within about 4 weeks of the referral (2 week cancer pathway appointment, then surgery about 10 days later).
She did need a skin graft, but 2 years on, it’s all fine. In case that helps reassure you with how quickly follow up is done.

They keep checking her, and are always really interested in her lymph glands in her neck, and armpits. Are they swollen in your dad?

In my opinion, as the daughter of an elderly person and not as a clinician, my instincts say that needs seeing sooner rather than later.

I wouldn’t go to A&E on a Friday night before a BH weekend, if ever, unless it was a matter of life and death. However, is there merit in rolling up at 7.30am tomorrow, on the cusp of a shift change, so staff will be sharper, the drunks will have gone home and the Saturday morning sports injuries won't be in?

I think he needs to be seen before 5th June op, if not for his clinical/physical wellbeing but also for your state of mind and general equilibrium.

Does he have any money stashed away to spend on this if yiu don't? Seriously, can you pawn anything tomorrow although a private appointment won't be before Tuesday now.

I see things like this on a daily basis as a nurse.

I don’t think this warrants urgent attention. Cysts/wounds etc naturally leak fluid, that is normal and not concerning. I have no idea why some has written that it’s necrotising, this isn’t even a word that is really used, and it certainly doesn’t look anything like a necrotic wound.

It is red and angry looking because it is inflamed, because it is (most likely) a whopping great big cyst. Inflammation does not equal infection. And also because we are looking at a photo, which always really ramps up the contrast and makes things look much redder.

There are no dermatologists in A&E. They will give you no more answers. At a best bet, they might give him a course of antibiotics, which from the very limited info I have I am not convinced he needs.

I understand that you are very worried, but there is little you can do. If it becomes hot (not warm but actually hot), painful (he struggles to let you touch the surrounding skin), it starts to suddenly smell very unpleasant, or redness starts tracking and spreading, call 111 for an assessment. I would expect other signs of infection to kick in before a wound started making lots of puss, so I don’t usually worry about puss if there are no other symptoms. Because he may find it harder to communicate his pain you may need to watch out for his non verbal cues, but reading these posts, it looks like you are pretty good at that already.

You’re doing a great job. Good luck!