Skin metastases and fungating tumours in patients receiving palliative care
Skin metastases and fungating tumours in patients receiving palliative care
Approximately 10% of individuals with metastatic cancer develop cutaneous metastases. These occur most often with carcinoma of the breast, malignant melanoma and mucosal tumours of the head and neck.
There are several general treatment options:
Treatment with external beam radiation is often effective in reducing size, bleeding and the complications of infection and odour. A second radiation treatment may be indicated at the discretion of the radiation oncologist.
Nonstick dressings are preferred to lessen surface bleeding. Using dressings that last longer and require only infrequent changes may reduce dressing-associated discomfort, and because they are changed less often, may not be more expensive overall than a dressing with a cheaper unit price.
Partial amputation of a florid tumour may assist.
Lesions can be ‘bagged’ as with a colostomy to collect secretions and contain odour. Early consultation with a specialised wound service is recommended.
Charcoal wound dressings assist in reducing odour.
For bleeding, consider
radiotherapy
application of local thrombin powder
topical use of the injectable form of the antifibrinolytic tranexamic acid (which has been reported to be effective)
adrenaline, which is effective, but only for a very short time
locally applied styptics such as silver nitrate (which, although sometimes used, have no good evidence of effectiveness).
Pain not controlled with good wound care and treatment of infection should be managed with systemic measures. Topical morphine (see Pressure sores) may be useful.
Fungating tumours may be associated with an unpleasant odour. To reduce the odour, use:
| | metronidazole 400 mg orally, twice daily or metronidazole 0.75% (7.5 mg/g) gel or a crushed 200 mg metronidazole tablet in water-based gel topically, to the affected areas with dressings. |
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