Problem: A 60-year-old Caucasian male with squamous cell carcinoma of the epiglottis developed severe wet desquamation and cellulitis of his neck following his 3rd cycle of radiation. He was admitted to acute care for Silver Sulfadiazine (SSD) treatment. The SSD was covered by gauze and secured with gauze wraps twice a day. Several areas of the SSD dressing were adhering to the patient's neck during dressing changes and his pain level was 6 on a scale of 1 to 10. It was difficult to keep the dressing over the entire desquamated area due to the shape and movement of the neck.

Past Management: SSD dressings twice a day were applied for three consecutive days with no improvement with dressing maintenance or patient's pain level. The severe wet desquamation continued.

Current Approach: The SSD dressings were discontinued. The wet desquamation areas were covered with a slow-released silver hydrofiber dressing with the goal to leave it in place and change only the outer gauze wrap twice a day. Using a slow-released silver hydrofiber dressing with moisture-retention capabilities are known to improve exudate management which decreases dressing changes, lessens the disruption of newly healed tissue, and improves patient comfort.

Outcomes: Re-epithelialization over 2/3 of the neck area occurred in less than 48 hours. Areas of adhered slow-released silver hydrofiber dressing were left in place for 3 more days. The patient's pain level decreased to 0-3. The patient finished radiation without further desquamation.

Conclusion: 60% of cancer patients are treated with radiation therapy. Neck cancer patients with desquamation can be challenging. Although a slow-released silver hydrofiber protocol for partial thickness burns decreases pain and increases re-epithelialization, the radiation regime cannot be concurrent. In this case study, the dramatic re-epithelialization time of 48 hours resulted in only minimal interruption of the radiation regime.