Malignant cutaneous wounds: a management protocol

Malignant cutaneous wounds are emotionally traumatic and difficult to manage lesions which occur secondary to infiltration of cancer into the skin. They occur in patients with end-stage disease and are highly exudative, malodorous, and bleed easily. Quality of life is the goal for treatment, which includes radiation, chemotherapy, surgery, and local wound care. Odor is addressed with varying levels of success through wound cleansing, external deodorizers, charcoal-impregnated dressings, topical antimicrobial therapy, and metronidazole. Exudate is managed with highly absorbent dressing materials, topical steroids or hyoscine (a drying agent). Light bleeding is controlled with local pressure and hemostatic dressings; heavier bleeding may require ligation or cauterization. Cosmetic appearance and other psychosocial issues must be assessed on an ongoing basis. Creative dressing techniques can help restore the look of symmetry to the patient's body. Effective wound management, debridement, and antimicrobial therapy can reduce the risk of infection. Wound cleansing, through irrigation or flushing, should not cause pain, further trauma or bleeding. Dressings should maintain a moist wound environment and not traumatize the wound upon removal. A protocol is included which can be individualized to the needs of each patient and addresses assessment, interventions, patient teaching, documentation, and expected outcomes.