Wounds can present in patients as a result of various etiologies. One cause of wounds not typically on most clinicians’ radars are wounds that result from primary tumors.

We spoke with Joni Brinker, MSN/MHA, RN, WCC, an Ohio-based consultant and clinical nurse educator with Optum Hospice Pharmacy Services of Eden Prairie, Minnesota, and speaker for WCEI’s Wild on Wounds (WOW) national conference, to gain insight on malignant wounds that can develop from primary tumors.

What Is a Malignant Wound?

“A malignant wound is a manifestation of malignant (cancerous) cells that have infiltrated through the skin,” said Brinker.

Other structures such as blood and lymphatic vessels also can be invaded by malignant cells and produce wounds, she said.

“It’s important to be aware that some clinicians use other terms that are synonymous with the term malignant wounds such as fungating wounds or metastatic wounds,” said Brinker.

Which Types of Tumors Can Manifest in the Skin?

Brinker said the most common type of malignant wound that results from a primary tumor is seen with breast cancer. “A high percentage of breast cancer patients experience malignant wounds on their chest.”

The second most common cause of malignant skin wounds are those that stem from the primary tumors of head and neck cancers. The third most commonly occurring skin wounds that develop are those resulting from groin and vaginal cancers, said Brinker.

She pointed out that any kind of primary tumor can result in a malignant wound or wounds. However, the three above are seen in greater numbers.

Some Typical Presentations of a Malignant Wound From a Primary Tumor

Brinker said some common presentations with malignant wounds are:

Nodules: Sometimes nodules are the first symptom a patient has. Nodules can be either painless or painful.

Skin color: The color of the skin can change from its baseline.

Hardening of the tissue: In breast cancer, sometimes the breast becomes excessively firm and feels harder than it did before.

Brinker said the way in which malignant wounds present depends on a few different factors such as:

  • Type of malignancy
  • Amount of growth
  • Level of infiltration

Wound Care/Treatments

For many patients, pain is the most significant issue they have with these wounds, said Brinker. “Because of that, the goal is to offer the patient various wound care options that can help reduce pain.”

To make patients more comfortable and scale down pain, integrating the use of different pain reducing and antimicrobial treatment modalities are part of the standard care.

“The use of oral and topical medications along with choosing the most appropriate dressings all play a role in providing optimal care and reducing pain,” she said.

Brinker said some of the more commonly used wound care methods and treatments are:

Oral Medications

Systemic pain medications: Both narcotic and non-narcotic pain medications used alone or in combination, as needed, can provide overall pain control and help prevent breakthrough pain.

Dexamethasone: This helps reduce inflammation, which can help reduce pain.

Systemic antibiotics: In addition to their obvious antimicrobial properties and ability to reduce pain, systemic antibiotics are especially helpful to use when wounds are malodorous.

Malodor in a malignant wound is embarrassing for patients and it negatively impacts their comfort level for socializing with others. Malodorous wounds strongly contribute to setting the stage for emotional and physical isolation for some patients.

Topical Medications and Treatments

Metronidazole: A topical anti-fungal agent

Morphine and Lidocaine: The topical route for these two medications is an option for use with painful dressing changes.

Epinephrine: A topical epinephrine preparation can help to reduce bleeding for wounds that tend to bleed heavily.

Autolytic Debridement

If devitalized tissue is present, Brinker prefers to use autolytic debridement, as it generally does not cause a wound to bleed.

“Autolytic debridement creates a moist environment while also utilizing the patient’s own wound fluids to promote healing and reduce the amount of unhealthy tissue.”

Dressings: Choosing the correct, non-adherent dressings that promote autolytic debridement is a way to utilize the patient’s own natural defenses in a painless way.

(The method of sharp debridement is not recommended for these wounds as using it can cause bleeding.)

Various dressings are available with regards to size and manufacturers’ recommended length of wear, said Brinker.

Does your patient prefer their dressings changed on a more frequent basis or do they prefer a longer interval between dressing changes? These factors can help you determine which dressings to choose, she said.

“As clinicians, the choice of dressings you make highlights why it’s so important to speak with the patient and their caregiver as to the patient’s wishes,” she said.

Gentle Irrigation

Gentle irrigation is a form of debridement. Gentle irrigation is preferred over a high-pressure irrigation due to the pain and increased risk of bleeding that comes with high pressure.

More on Dressing Choices

If a wound tends to bleed or has heavy exudates, calcium alginate or hydrogel dressings are a good option to consider, as they are highly absorptive.

Another option for a heavily exudative wound is to use a wound pouch.

Brinker pointed out that with some areas of the body, it can be difficult to find perfectly fitted dressings — chest wounds that cover larger swaths of the body being one example. These sometimes require the use of several abdomen-sized pads to wrap and fit well around the area of the body involved, yet maintain the most comfort possible for the patient, said Brinker.

“With some wounds you have to get creative,” she said. “Clinicians need to consider the importance of honoring their patients’ wishes and those of the family or caregiver, while also providing evidence-based wound care.”

Take our engaging, evidence-based Wound Care Certification Courses for nurse, registered dietitians, physical therapists, and more professionals. Choose the format that suits you and get access to tools to help you ace your exam.

Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

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