Malignant fungating wounds: assessment and management

Approximately 5-10% of patients with metastatic cancer will develop a fungating wound. The disfiguring or unpleasant nature of these wounds can lead to complex psychosocial problems in patients, which mean that many will seek medical assistance only when the wound is advanced. Curative treatment is often not an option, although a range of palliative treatments may be tried. When the tumour does not respond to these treatments the patient will be left with a chronic complex wound with local wound management as the only option. It is at this time that the community nurse usually becomes involved with the patient. This article discusses the assessment of patients with fungating wounds in the community, taking into consideration the immense psychological distress that they can cause. It highlights factors that need to be taken into consideration when assessing these complex wounds. Many of them are heavily exuding, malodorous and bleed easily. Strategies that focus on managing these symptoms are explored and recommendations for clinical practice are made.