Fungating breast cancer and other malignant wounds: epidemiology, assessment and management

ABSTRACTMalignant fungating wounds are often associated with advanced malignancy especially breast cancer. There is no consensus regarding the optimal management of thiscommon condition. The ideal management of these patients requires a multidisciplinary and holistic approach. Malodour is one of the most distressing symptom and the use of topical metronidazole is commonly cited. Pain management requires an accurate assessment to treat the underlying cause and the WHO analgesic ladder is often used to guide pharmacologic therapy. Bleeding fungating wounds can be treated with natural hemostats, sclerosing agents, coagulants or other topical agents. Highly exudative wounds may require the use of specialized dressings such as alginates, hydrofibre and foam dressings or alternatively, highly absorbent pads. These recommendations are based on anecdotal evidence and small underpowered studies. Hence, larger clinical studies are warranted to determine the optimal management strategies for malignant fungating wounds.