Malignant wounds most frequently take the form of skin ulceration, mainly as a result of basal-cell and squamous cell carcinoma or a metastasis. The skin changes may take the form of warts, ulcers, cauliflower-like and extensive pathological lesions.
Malignant wound may be a result of a primary cancer (e.g. skin, head or neck area) or a metastasis to other organs. Lung, breast or large intestine cancers and melanoma often cause metastases to the skin.
Tumors in distant sites like stomach, pancreas or small pelvis can cause metastases to the naval area and are referred to as Mary Joseph nodule. Wounds secondary to malignancy can also occur on the back, trunk, abdomen, groins or armpits, genitals and limbs. Chronic malignant ulceration is caused by uncontrolled growth of various types of cells, and they most often include ulcering tumors, sarcomas, melanomas or lymphomas.
Chronic wound, such as in the case of lymphatic oedema, which are accompanied by prolonged ulceration can transform into malignant change, known as Marjolin’s ulcer.
Metastasis-related wounds on the skin indicate an advanced stage of a neoplastic disease.
Increased risk of malignant wounds:
- genetic susceptibility
- excessive exposure to UV radiation
- immunosupressive medication (eg. cyclosporin)
- long-lasting wound healing (post-burn, post-radiotherapy, vascular co-morbidities)
Appropriate treatment based on the laboratory smear analysis and histopathology of the skin sample can enhance therapeutic results. Nowadays, thanks to histopathological tests, many, so far incurable, malignant ulcerations can be effectively controlled with combined methods e.g. immunoprotective treatment of melanoma or chemo- and radiotherapy of lymphoma. Malignant wound management must include both local and systemic treatment. In primary histological lesions it involves surgical removal, radiotherapy and/or systemic treatment, which is considered to be a priority therapeutic action.
Malignant wounds may be present with bleeding, irritation, pain and odour connected with skin cell loss or degeneration, which may lead to feelings of distress and social isolation.
Malignant wound treatment and care should be conducted by a team of experts. Long-lasting dressings, properly selected to absorb and contain exudate and odour can bring relief. Additionally, it is possible to administer appropriate analgesia which both re-hydrates the skin and eases the pain.
Symptom treatment provided by our experts aims at selecting appropriate materials and agents as well as improving the patient’s life quality, which involves teaching patients and their families dressing change and wound care.
Photo gallery of cases:
Patient 1. A 62-year-old patient came to the clinic complaining about ‘fat legs’ of unknown aetiology as he had never been properly diagnosed.
The patient’s history revealed that he was being treated for prostate gland cancer. Prolonged lymphatic oedema and, what is more important, lack of any compression therapy aggravated the condition. Complications led to trophic changes on the whole skin area of the lower limbs and lymph-leaking cracks causing chronic inflammation. Ultimately, years of ineffective treatment resulted in elephantiasis and systemic complications.
Oedema caused intense pain in the middle section of the lower limbs. The tension caused lymph secretion which formed the environment for bacteria and fungi proliferation that, in turn, created a hard crust covered with i.a. mould. Reduced blood supply led to toes fungal infection and ingrown toenails.
Skin surface mechanical cleaning and disinfecting with multifunctional agents. Fissure drainage and agents application.
Phytotherapeutic baths of astringency, antibacterial and antifungal properties.
The fissures were disinfected, long-lasting silver dressings, foam dressings and compression pads were applied.
Intensive care resulted in significant skin cleansing which reduced the tension and pain as well as the patient’s discomfort. Inflammation control eliminated purulent skin lesions and, consequently, improved everyday functioning and life quality in general.
The results after 2 months.
Patient 2. A patient reported the sensation of a corn formed on the 5th toe of her left foot. What was found in history was a breast amputation she had undergone several years earlier. Suspicious look and shape of the skin change along with the palpation diagnosis suggested the need for further histopathological diagnostics. The laboratory analysis confirmed the presence of cancerous cells.
The patient had her toe amputated in hospital. The wound healed quickly with no complications.
Quick identification of malignant lesions on the feet or in the wounds facilitates positive treatment outcome.