How do you approach biopsy and management decisions for a rapidly enlarging periocular tumor in an elderly patient with dementia who is unable to communicate and whose family prefers to avoid aggressive treatment?  

In elderly and frail individuals, which would include this patient, there are 5 options. One is to do nothing, which at the end of life (who can predict) is reasonable for basal cells and more difficult in squamous cells. Another is to consider radiation. The orbital area is often felt to be a plac...