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Question
Posted by: Worried | 2004/11/01

Nose lesion

I noticed what I thought was a scratch on my Persian's nose about a week ago. I took him to the vet and he was put on antibiotics for 8 days. It hasn't cleared so he has to go for a biopsy. What's the prognosis if it is cancerous, would it be worth amputating his nose or would it be more humane to let him go?

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Our expert says:
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The following extract is from my website:

Squamous-cell carcinoma of cats: The sun induced skin cancer

On radio, television and in the printed media we humans are constantly warned about the dangers of exposure to the harmful rays of the sun. We are warned to cover our skin, avoid direct sunlight especially during the middle of the day and to apply sun block when we do expose ourselves to the sun. This all, to prevent the formation of skin cancer in later life. Well, the same rules should apply to cats. Most cats are lucky: The skin is covered with hair that block out the harmful rays and the hairless areas are usually protected by pigment in the skin. However, just as fair-skinned people are more prone to sunburn, so fair skinned cats are more prone to sunburn. White cats and other cats with white body parts are most likely to develop problems. The most susceptible areas in these cats to cancer formation are the ear tips, eyelids and the tip of the nose.

With chronic excessive exposure to the sun, the white or hairless parts of the skin initially get sunburnt and may later develop precancerous changes known as actinic dermatitis. This may be visible especially in the older cat (and especially in cats that enjoy basking in the sun) as flakiness, crustiness and mild hair loss of the ear tips or nose. If left untreated, these areas will eventually become cancerous, the most common cancer being squamous-cell carcinoma. The cancerous lesion may be recognised as ulceration or destruction of the normal tissue, very often covered with a crust. This may look like a wound that is slow to heal. Usually a small tissue sample must be obtained and analysed to confirm the diagnosis and determine whether the lesion is cancerous or precancerous.

The precancerous lesions can be treated by restricting further exposure to the sun, the application of sunscreens, application of corticosteroid creams or the use of specialised drugs such as etretinate, and freeze therapy (cryotherapy). Once the area has become cancerous, medical therapy is no longer effective. Surgical removal of the ear tips or nose is then the most effective treatment and should be performed early, as soon as the problem is discovered. The earlier surgery is performed, the smaller the amount of ear or nasal tip that must be removed and the less likely that spread of the cancer may have occurred. In some cases, the entire ear and ear canal may need to be removed to prevent spread of the cancer. It is always safer to remove too much tissue rather than too little. With cryotherapy, freezing of the affected areas is performed. This kills off abnormal and also some normal tissue, whereafter the body will heal the wound. This can be very effective, but it may be difficult to control the amount of tissue loss. If the lesion is left untreated too long, the affected area may be too deep for cryosurgery to be effective, especially on the tip of the nose. In cases where the cancer is too deep for surgery or cryotherapy, a chemotherapy drug mixture is injected into the problem area once weekly, for four weeks. This may be combined with cryotherapy. This method of so-called intralesional chemotherapy can be extremely effective and rewarding. There are no systemic side-effects. Even in advanced cancerous lesions, control can be achieved for prolonged periods of time. The treatment can be repeated as necessary. Lastly, in some cases and where available, radiation treatment of cancerous lesions can be performed. This type of treatment again result in no systemic side-effects. Once surgical treatment, cryotherapy, chemotherapy or radiation has been performed, it is important to limit further exposure to the sun. Continuous sun-exposure will result in recurrence of the cancer. Tattooing or injection of die into the skin is not effective to prevent cancer and is no longer performed.

To summarise, the approach should be: Limit exposure to sunlight, apply sunscreen, and be observant. The earlier a problem is discovered, the more effective it can be treated and the less impact it will have on your cat. Early treatment is not only safer, it is also less costly. Early and aggressive surgery or cryotherapy is strongly recommended. Do not be scared of aggressive surgical removal of affected parts, as this may save the cat's life. And remember, once treated, avoid further excessive sun exposure.

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Finally, I can only generally recommend that surgery and removal of the nasal tip can save the cat's life and is definitely performed with the cat's benefit in mind, and should be seen as a humane treatment. Euthanasia at this stage is definitely not necessary.

Dr Malan van Zyl
Veterinary Specialist Physician
Cape Town

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

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Our users say:
Posted by: Worried | 2004/11/04

Thanks for the advice. I decided to go the biopsy route. My vet, after taking a second look seems more convinced now that it's an infection. The biopsy was done as a precation becaes he's a white cat, so now we wait for the result. The nose itself is looking much better after beinig cleaned and the introduction of a stronger antibiotic. He seems to have regained his appetite and attitude. The vet also showed me pictures of what it would look like if the nose should have to be amputated and it looks a lot less scary than I initially thought! So once again, many thanks.

Reply to Worried
Posted by: Chill | 2004/11/01

Hey... don't EXPECT the worst! Maybe it's not that serious at all.

But, Acineth is right... if it is, you must be guided by your vet.

Good luck.

Reply to Chill
Posted by: Acineth | 2004/11/01

This is a terrible decision to make. I've been there, and the only advice I can give you is to discuss the cat's future quality of life with the vet and make your decision based on the information you're given.

Reply to Acineth

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