How Common Are They? 5-10% of patients with metastatic cancer will develop a malignant wound! Wound Care Designed to afford Relief without Cure
Most Common Sites Breast Head/Neck Back/Trunk/Abdomen Groin/Axilla Genital
How do they develop?
From a Primary Skin cancer left untreated. Ie. Basal cell ca Squamous cell ca
A Primary Tumor invading up into and through the skin. Ie. Breast tumor
Tumor has invaded blood or lymph vessels – small skin capillaries trap malignant cells
During Surgery – seeding of malignant cells in the dermis occurs
Conversion: Malignant wound develops in another chronic ulcer/scar tissue
PATHOPHYSIOLOGY! Starts as discrete, non tender nodules Can be skin tone, pink, red, violet, blue, black or brown! As malignant cells grow and divide, the nodules enlarge – interfere with skin capillaries and lymph vessels
Tumor very disorganized! – poor skin perfusion, edema and necrosis occurs Tumors often extend into deeper structures – sinus and fistula formation
SURGERY Used occasionally to reduce tumor mass but may not always be possible due to bleeding, infection, etc.
Chemotherapy Can decrease tumor mass Depends on tumor response
RADIOTHERAPY Can reduce the size of mass – controlling exudate, bleeding and pain Adding radiotherapy reactions to wound
ASSESSMENT Location of Wound Size, Depth and Shape Amount and Nature of Exudate Presence and Level of Malodor Type of Tissue Present Signs and Symptoms of Infection Nature and Type of Pain Condition of Peri-wound Bleeding
ASSOCIATED PROBLEMS WHAT DOES THE PATIENT THINK IS THE MOST IMPORTANT?
ODOR!! Anaerobic Bacteria infecting or colonizing necrotic tissue-Putrescine, Cadaverine Klebsiella, Pseudomonas & Proteus Necrotic Tissue Odor Stale Exudate