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
One method of dressing a large fungating breast carcinoma is
dressing with warm water or in the bath.
gauze soaked in 1:1,000 adrenaline over any bleeding points
until they stop.
with warm saline. Antiseptics are only necessary if there is
a heavy infected exudate.
Iyofoam dressing may control a persistent bleeding point.
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
non-adherent dressing. Cavities should be loosely packed
with an absorbent non-adherent dressing (such as an alginate
foam or other absorbent dressing to soak up exudate.
dressings in place with tubular elastic netting, which is
better than the repeated use of adhesive strapping.
charcoal pads under the netting to absorb smell these are
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.