Fungating of cancer onto the skin surface occurs most commonly with carcinoma of the breast, but occurs occasionally at other sites (vulva, rectum). The lesion may be a small dry crusted area needing only a gauze pad, or a large ulcerated area with profuse exudate and capillary bleeding needing dressings 2 times a day. Radiotherapy, chemotherapy or hormone therapy can sometimes produce skin healing.

«  Fungating lesions are disfiguring, distressing and isolating. The way in which the dressing is done is as important as the dressing itself.

One method of dressing a large fungating breast carcinoma is as follows:

  • Soak off dressing with warm water or in the bath.

  • Hold gauze soaked in 1:1,000 adrenaline over any bleeding points until they stop.

  • Irrigate with warm saline. Antiseptics are only necessary if there is a heavy infected exudate.

  • A small Iyofoam dressing may control a persistent bleeding point.

  • Irrigate with metronidazole solution or apply sterile metronidazole gel. (The gel is better. It is soothing and stays on the chest wall, and reduces infection and smell. The gel should shortly be available in the United States.) A cheaper alternative is natural yogurt, which is soothing and also reduces anaerobic infection. (Wash off any antiseptic before applying yogurt.)

  • Apply a non-adherent dressing. Cavities should be loosely packed with an absorbent non-adherent dressing (such as an alginate dressing).

  • Apply foam or other absorbent dressing to soak up exudate.

  • Hold dressings in place with tubular elastic netting, which is better than the repeated use of adhesive strapping.

  • Place charcoal pads under the netting to absorb smell  –these are very effective.

If smell is severe give oral metronidazole 500mg 3 times a day. A broad spectrum antibiotic may be necessary in addition. Smell is very difficult to control if the wound contains black necrotic tissue. This should be removed by painting with streptokinase (an enzymatic desloughing agent) which dissolves the slough. Large areas may need surgical debridement. Avoid chemical desloughing agents which can cause soreness. (see Pressure Sores)

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.

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