All the Pink Ladies in the Orchard are Not Enough: Best Practice for Management of a Patient with an Ulcerating Malignant Wound

Each year more than 1 million cases of skin cancer are diagnosed in the United States.  In the presence of advanced disease, a multidisciplinary approach changes as the disease progresses. The team consists of a nurse, a WOC nurse, a nurse aide, Social Worker, or Case Manager. Most of the care is centered on the patient and the wound. Patients who choose to be cared for at home do not have 24 hour / day care. The family provides this care. The patient is able to drive care including nutrition, time spent in chair or bed, turning, and positioning. The degree of non-compliance may override compliance.  This renders the patient at higher risk for pressure ulcer formation, related to limited support systems.  Maintenance of the household, palliative care providers, family working and being caregivers led to restless nights and periods of exhaustion.

The poster is the case study of an 82 year old man and his 16 month battle with advanced poorly differentiated squamous cell cancer. His history of skin cancer began during his late 50’s starting with Basal Cell Cancer, followed by Squamous Cell, MOHS surgeries, radiation therapy, and a single episode of Melanoma requiring wide excision. The appearance of lesion the size of an egg, alerted him to seek medical advice.  Surgical biopsy followed by 4 weeks of radiation therapy, led to a journey for which he was ill prepared. Living with a fungating tumor presents challenges for which standard wound care does not solve: Drainage, odor, pain, securement and minimizing frequency of dressing change.  This poster illustrates how aggressive an ulcerative fungating tumor evolves at 3 month intervals, and the patient family journey.

Malignant Fungating wounds defy standard wound care treatment. Goals of care are outlined and evidence based treatment for each goal. More research is needed.