Fungating Wounds: management and treatment options

Fungating wounds are ‘…ulceration and proliferation which arises when malignant tumour cells infiltrate and erode through the skin’.^1,2 These wounds or lesions as they may be referred to, commonly develop in the last few months of life, although it is argued that in exceptional cases they can be present for a number of years if the disease is localised. Alexander³ stated that fungating wounds are unlikely to heal; between 5 and 15% of people with a metastatic cancer diagnosis develop a fungating wound⁴ and 9% of all cancer patients.⁵

Adderley and Holt⁶ concluded in their systematic review that fungating wounds occur as a consequence of primary, secondary or recurrent malignant disease (cancer). Primary skin tumours that can fungate include malignant melanomas, squamous-cell carcinomas and basal-cell carcinomas. Basal-cell carcinomas are frequently prone to fungation, however, they rarely metastasise.⁷ Malignant changes can also be experienced in chronic wounds such as leg ulcers.⁸ At present there are no exact statistics on the incidence of fungating wounds as it is not recorded in any population-centred cancer registers. Estimates vary between 5% and 10%.⁹