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Malignant Wound Care and Advanced Illness Management

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Pearls and Pitfalls in Skin Ulcer Management

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Abstract

Cancerous wounds or malignant fungating wounds (MFWs) are non-healing chronic painful wounds, that arise in advanced and uncontrolled cancer, as a result of cancerous cells infiltrating cutaneous and subcutaneous tissue, by skin and nonskin cancers. These wounds, due to increased necrosis and infection, and high malodorous discharge, have a detrimental effect on several aspects of the patient’s life in their last few months (Grocott et al. Curr Opin Support Palliat Care. 7(1):101–5, 2013; Furka et al. Cancers. 14(5):1203, 2022).

The incidence of cancer is raising, mainly caused by an ageing population (Weir et al. Cancer. 121(11):1827–37, 2015).

In the meantime, an increase of patients with advanced-stage tumors was registered, probably as a consequence of the delay induced by the restrictions related to public health containment measures for the SARS-CoV-2 infection and managing a chronic disease in such a setting, may result extremely demanding (Lo et al. J Clin Nurs. 17(20):2699–708, 2008).

The treatment of cutaneous tumors, regardless of their histological origin, usually requires a surgical approach, considered being the most effective when applicable. However, due to the severity and debilitating nature of MFWs, surgery might not be always considered a feasible option, and managing these wounds requires integrated palliative care until death. According to the World Health Organization, palliative care is an “approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual” (Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care). Nowadays, a multidisciplinary approach to cancerous wound treatment is mandatory.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Experimental and Clinical Medicine Department, Magna Graecia University of Catanzaro, Catanzaro, Italy

    Marco Marcasciano, Antonello Greto Ciriaco, Maria Antonia Fiorillo & Manfredi Greco

  2. Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Department of Surgery “P. Valdoni”, Sapienza University of Rome, Rome, Italy

    Jacopo Nanni

  3. Department of Breast Cancer Surgery, Azienda Ospedaliero-Universitaria Senese, Siena, Italy

    Donato Casella

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  1. Marco Marcasciano
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  4. Maria Antonia Fiorillo
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Editors and Affiliations

  1. Unit of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Jonic Area, University of Bari, Bari, Italy

    Michele Maruccia

  2. Plastic Surgery Unit, University of Trieste, Cattinara Hospital, Trieste, Italy

    Giovanni Papa

  3. Difficult Wound Healing Unit, Policlinico di Monza, Vercelli, Italy, Italy

    Elia Ricci

  4. Plastic and Reconstructive Surgery, University of Bari Aldo Moro, Bari, Italy

    Giuseppe Giudice

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Marcasciano, M., Nanni, J., Greto Ciriaco, A., Fiorillo, M.A., Casella, D., Greco, M. (2023). Malignant Wound Care and Advanced Illness Management. In: Maruccia, M., Papa, G., Ricci, E., Giudice, G. (eds) Pearls and Pitfalls in Skin Ulcer Management. Springer, Cham. https://doi.org/10.1007/978-3-031-45453-0_50

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