Interesting that you ask this question. We have the same experience of acromegaly and mast cell tumors with our girl Piper.
Here's her history:
Jan 2021: Diagnosed with a mast cell tumor in her spleen and had a splenectomy in Feb 21 - she had no obvious symptoms, it was just that she was "lumpy" on one side & we got it checked out. Her spleen was 1.5lbs when removed.
Nov 2021: She crashed with DKA/pancreatitis and was diagnosed as diabetic.
May 2022: IGF-1 test positive for acromegaly.
Sep 2022: Diagnosed with multiple mast cell tumors on her head and neck. She had surgery to remove them - especially as one was bigger on her head (it had been there close to a year but changed & grew to look nasty).
Oct 2022: Cabergoline trial - no benefit to BG numbers & she got very sick on it, so we stopped treatment.
Nov 2022: Additional skin mast cell tumors confirmed.
At that point we elected to not do any additional surgeries. There would not have been enough skin to get clear margins & we didn't want to put her through surgery again.
It's now 12 months since her skin surgery & the various tumors round her head/neck really do seem to be very slow growing.
We've done ultrasounds since the splenectomy to check nothing else is going on internally - all they have reported is a general thickening of her organs from the acromegaly.
She only had a 12-month life expectancy after the splenectomy and we are nearly up to 3 years. I'm not sure if there were skin tumors earlier than we realized.
She's living her best life and currently has great BG numbers on a low dose of Lantus, so we are happy with our choice to watch/wait and hold off on more surgeries.
Not sure if any of this helps but I hope you can figure out the best course of action for Bootsie
