Malignant Fungating Wounds in Locally Aggressive Cutaneous Squamous Cell Carcinoma: A Case Series

Despite surgical removal being considered the first-line treatment, managing high-risk squamous cell carcinoma (SCC) cases remains challenging and lacks uniformity as associated complications of less common secondary bacterial infections are underreported. The skin, as well as its appendages, constitute the first line of defense against infectious pathogens. In patients with locally aggressive skin cancers, susceptibility to infectious microorganisms is elevated due to skin lesions and immunosuppression resulting from chemotherapy, surgery, immunotherapy, and stem cell transplantation. Furthermore, immunosuppressed patient populations, when infected, often have extended disease duration and heightened disease burden. Malignant fungating wounds (MFWs), cancerous lesions that typically occur during the terminal stages of a patient's illness when tumors infiltrate the skin and surrounding tissue, may further complicate cases as they often can be misdiagnosed as abscesses or infections. Due to this, we sought to thoroughly characterize the disease progression, treatment efficacy, and risk factors of two patients with locally aggressive SCCs afflicted with MFWs and secondary Pseudomonas aeruginosa (P. aeruginosa)infections. We report two cases of cutaneous SCC (cSCC) in immunocompromised patients, one with HIV and the other a lung transplant recipient on chronic immunosuppression. Both cases were complicated by extensive tumor invasion, chronic infection, and multidrug-resistant P. aeruginosa. These cases highlight the aggressive nature of cSCC in immunocompromised individuals and the complexities of balancing oncologic treatment, palliative care, and infectious disease management.