Open Sore On Leg - Basal Cell Tumor - Incomplete Excision

I'm only asking this here because I probably won't be able to see the vet until Friday due to the snow storm heading my way. I'm going to call first thing in the morning (Monday), but they probably won't be able to squeeze us in. I'm concerned about what's going on with my cat, so I thought maybe some people here could help while I'm waiting.

I have a 14 y/o, indoor only, male cat, Shorty, who has what may be a tumor on his front leg. There's an open, flat sore about the size of a penny that isn't healing very well. He's been on Amoxicillin (50 mg twice daily) for a week, but I'm not seeing any improvement. If anything, it may be worse.

He was prescribed the Amoxicillin for a herpes virus flare-up without being seen (he has a history of flare ups). I noticed the sore about two days before I got the prescription filled at my local pharmacy. At first, I figured it was one of the mysterious sores like he's had on his paw pads before, which was treated with antibiotics. So I let it go since it had already scabbed over. I figured the antibiotics would help. But Thursday, I noticed it was open and nasty looking so I wrapped it up so it wouldn't get cat litter and hair in it. But now I'm not seeing any improvement. There may be a lump or something under the skin.

Based on pictures I'm looking at on the internet, it appears it may be a tumor. At this point, the area is flat, not raised. It started bleeding from one little spot Saturday night when I replaced the dressing, but that was probably because Shorty was trying to pull the bandage off. It looks better today (Sunday) than it did Saturday. It's near his claw (the one equivalent to our thumb) on the side of his leg. The area seems painful to him. He certainly fusses at me when I try to treat the area.

Like I said, I'm calling the vet Monday morning, but I doubt I'll make it in before Friday due to the snow.

Does anyone have any thoughts or advice? If it sounds like cancer, does anyone have any info on whether the leg would need to be amputated? Can the regular vet do that? How much does it cost? I'd like to have an idea as to what I want to do before we see the vet.

You are getting way ahead of yourself with all the cancer questions!  Stay in TODAY.  Whatever it is, it is not life-threatening immediately, so just take one step at a time.  Do try to see the vet tomorrow if possible, or alternatively see another vet if yours is too busy, which would also give you a second opinion in the long run.  If the dressing is annoying him, try leaving it off and letting him go ahead and lick the area like any normal cat will lick any normal wound.  Think positive if you can, because thinking negatively in the future just creates anxiety, and neither you nor your cat will benefit from that.  Take one day at a time, and don't forget to breathe!

Thanks, but that's just how I am - always thinking ahead. I just want to have a game plan in place. Last time I had an emergency (stray hit by a car), there wasn't time to research or sit and think about the different options. I had to make a decision fairly quickly. I hate that. I like to take my time.

In this case, the sore just came out of no where (it wasn't caused by an animal or injury). It's not quite like the sores that Shorty had on his paw pads. Sores like this don't typically come out of no where - there's a reason and usually bad. Now that I think about it, he has lost some weight. He's always been on the pudgy side and I attributed the weight loss to aging and his choice to eat the brand name dry food the younger cats eat vs. the slightly better quality dry food he had been eating. Plus, I had started letting him free-feed vs. the scheduled feedings he's had over the last 13 years.

So... it is a tumor.

The vet took a smear of the blood from it and examined it under the microscope. I forget the exact name of the cells, but it falls under soft tissue sarcomas. The particular type are known to grow rapidly (I got this part from the internet, not the vet). He said he didn't know if it is benign or malignant. I wish I had done more research beforehand. His approach is to treat with oral antibiotics and a topical of some sort to see what happens. He wants me to keep it uncovered to let it dry out and scab over. I don't understand this entire approach. Shouldn't something a little more aggressive be done, especially if the type grows rapidly?

He talked about possibly cutting it out and sending it to be analyzed. He said the location was tricky because it's on the leg and there isn't much to work with (I guess because it's primarily bony). I believe he said he could do the surgery there (thank goodness).

What do you all think? In my 27+ years of caring for cats, this is the first skin tumor/cancer I've come across.

I think you should get it biopsied and send it out to see if it's cancerous and go from their. What good does it do to treat it with antibiotics. If it's not cancerous then it'll be fine with some tlc, but if it is cancerous then ever day counts when it comes to getting it removed before it spreads. That being said your local vet is not a specialist and is kinda like your primary care doctor. Good for certain things but probably not as good as a licenced oncologist. Their may be a veterinary oncologist withing a few hours of you that may be able to help more.

First of all I wish you could remember the type of cells. This is important.

My opinion here...

Wasting time with antibiotic treatment, this is not going to be affected with med.

A soft tissue sarcoma needs aggressive treatment/removal now for the best outcome.

If the tumor is movable, as in not attached to the leg structure but to the skin/underside of skin, it needs to be removed, benign or not.

At this point it is not a big major surgery, he can cut it out plus a good amt of skin surrounding it to remove any cells in case it is malignant, leaving just enough to suture it closed after removal. If this is not possible then he can skin graft from another area where there is excess skin.

He should send it off to be examined and diagnosed.

If malignant, you would be watching it carefully to see whether it started growing a sore again, if it does that would be when amputation would be considered, to save his life basically.

These are deep rooted, so it's not simply taking the tumor but the surrounding skin is equally important so it removes all cancerous cells.

They're spindle cells.

I got the vet's office to email me the notes from the visit. They said that they're "not sure if it is a tumor or if it is just infected". I guess that's why they prescribed Clindamycin. However, Shorty has already been on Amoxicillin for three weeks with no improvement. They did prescribe a topical which has a steroid in it. I'm still waiting for it to arrive.

I made another post a few days ago about my problems ordering the prescriptions - http://www.thecatsite.com/t/336313/online-pharmacy-approval-delay-wasting-valuable-time

Basically, I was told to order online and it took forever to get the authorization. I should have the medicine by the 30th. However, the 14 day recheck with the vet is scheduled for the 31st. I'll be lucky if I have the meds by then. So I've essentially lost two weeks because the vet wanted me to order online. I don't think they carry the topical there in the office. They should have the Clindamycin, but it wasn't even offered to me and I didn't think to ask. I'm kind of ticked off now.

I don't get it. If the sore shows cancerous cells, then why are they not sure if it's a tumor or just an infected sore?

The vet said so many different things in regards to treatment, but never gave me any choices. I feel like I should call the vet's office, but I don't know what to ask exactly, because nothing about this makes sense to me.

kh2b1 said:

They're spindle cells.

I got the vet's office to email me the notes from the visit. They said that they're "not sure if it is a tumor or if it is just infected". I guess that's why they prescribed Clindamycin. However, Shorty has already been on Amoxicillin for three weeks with no improvement. They did prescribe a topical which has a steroid in it. I'm still waiting for it to arrive.

I made another post a few days ago about my problems ordering the prescriptions - http://www.thecatsite.com/t/336313/online-pharmacy-approval-delay-wasting-valuable-time

Basically, I was told to order online and it took forever to get the authorization. I should have the medicine by the 30th. However, the 14 day recheck with the vet is scheduled for the 31st. I'll be lucky if I have the meds by then. So I've essentially lost two weeks because the vet wanted me to order online. I don't think they carry the topical there in the office. They should have the Clindamycin, but it wasn't even offered to me and I didn't think to ask. I'm kind of ticked off now.

I don't get it. If the sore shows cancerous cells, then why are they not sure if it's a tumor or just an infected sore?

The vet said so many different things in regards to treatment, but never gave me any choices. I feel like I should call the vet's office, but I don't know what to ask exactly, because nothing about this makes sense to me.

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Sit down and write out everything you are thinking about. You have most of your questions here in this thread.
Then, look at what you have written and make your questions from the thoughts.

1- Can they sell you the antibiotics?
2- Is there a formulating pharmacy anywhere near you who can prepare the medicine?
3-Why are they giving antibiotics if they think it is cancer?

I think you get the idea from these. Call the office. Insist to talk with the vet or vet tech, not the receptionist. Use your written questions and take notes.

Take pictures of your kitty's leg. Hold a ruler next to the sore. That gives you a way to track how big it is.

I hope this helps. If you write your questions down, you will know exactly what to ask and can get the answer you need

Spindle cells are generally the malignant type, slower growing appearance-wise but rooting deep and capacity for metasticizing means act now.

Get that tumor off of kitty's leg ASAP for the best outcome.

This has become unfortunately frustrating. Shortly after my last post, I got very sidetracked with the health problems of another cat - Tiger, who has advanced CRF. I think him and a younger cat are both urinating outside the litter boxes and Shorty keeps stepping in it and getting his bandaging wet. It's been a real nightmare here because I've three 13+ cats all with serious health problems. Then I may have the younger one (4 y/o) who appears to have behavioral issues. I had to reschedule Shorty's recheck and never got to ask the vet about the antibiotics (I forgot). Now I feel really bad about it. I hope nothing has spread. The "sore" looks a litte better though. I will ask why they prescribed antibiotics and didn't just go ahead and do surgery.

I don't know how much I can afford to spend on Shorty's healthcare. I would think an oncologist would be very expensive. Can anyone make (more) suggestions on what choices might be available and what they entail? I'm pretty darn sure that things like chemo and radiation are going to be too expensive. I usually spend hours researching, but I just don't have the time anymore. I'm burnt out. I can't even think straight, I keep making silly mistakes.

I am a human physician in internal medicine, not a vet, but spindle cell sarcomas in cats and humans are usually highly malignant and should be seen by a specialist oncologist if possible and as soon as possible. 

Sarcomas are malignant tumours that occur in connective tissue, wheras carcinomas occur in cellular tissue.  Both metastasize (spread to other parts of the body by lymph glands or via the blood stream) and are classed as cancer. 

The earlier you have Shorty seen by a vet who knows what to do the better.  I recommend a feline oncologist, regardless of cost, and as soon as possible for the sake of the cat, but if there is none where you live. (you have not stated where you live) I recommend a second opinion by another vet who is aware of the treatment. 

Incidentally, antibiotics are usually of little value unless the tumour is infected. 

Treatment involves excision in the earlier stages, together with radiation and/or chemotherapy,  In later stages the prognosis is grim, unless amputation is involved - hence the need for an accurate diagnosis and early treatment. 

If you are worried about cost, and the lesion is a sarcoma, then perhaps you should consider amputation as the best option. 

With best of wishes to you both,

Geoffrey

Are you fully aware that this thread you started a full month ago and he still has that growing on his body and in his body?

If money is an issue then don't fool around, get his leg amputated. ASAP.

Just get it gone!

Otherwise there is no good that can possibly come from a malignancy being allowed to grow and metasticize, none.

Shorty's biopsy results came in last week and I have questions and concerns. The vet hasn't gotten back to me to discuss things. There's a nasty infection in Shorty's paw. From the biopsy results, it looks like there might have been something already going on with the paw prior to surgery that wasn't obvious. It appears the surgery aggravated the condition. Anyway, the vet has been playing phone tag with the pathologist, dermatologist, and some other specialist for the last week trying to figure out what to do.

Onto the diagnosis:

Firstly, the diagnosis is a hair follicule tumor - basal cell. But the pathologist said the excision was incomplete. I know that means there's a greater chance of recurrence, but is the veterinarian to blame in this? I remember he commented prior to surgery that it would be difficult to remove because it was so close to the bone.

With this type of tumor, is any other treatment needed especially since the whole thing wasn't removed? I can't afford things like radiation and chemo. Though I did hear about a chemo gel on another site.

Before the tumor was removed, the vet took a blood smear from the tumor , looked at it under the microsope, and saw spindle cells. Is it normal to see spindle cells in a basal cell tumor? I thought spindle cells were a type of cancer in the same way basal cells are.

Does anyone have any thoughts on this? There's got to be someone here who has experience with this type of thing.

One last thing, since the surgery, Shorty will not eat much dry food anymore. He's eating primarily canned food and it's giving him loose stools. I had him on a perfect balance of dry and canned that prevented the loose stools. But now, I can't get him to eat dry and he's losing weight - almost a pound in the last month. He's also not eating as much canned food as he should because he's a night eater and I can't feed him canned food while I'm sleeping.
Any thoughts on this matter?