Malignant Skin Ulcer

Question 1

How should I manage a malignant skin ulcer?

Answer 1

Ensure a professional with expertise in wound management is involved in the person’s care (such as a district nurse, palliative care or tissue viability nurse).
Assess the skin ulcer for its location, size, and whether it is ulcerative or proliferation as these factors affecting dressing choice. The amount of necrotic tissue within the ulcer, as this affects the need for cleansing or debridement
The condition of the surrounding skin, which may affect dressing choice, the method of securing the dressing, and the frequency of dressing changes
Assess for complications as well

Question 2

Wound cleansing and debridement

Answer 2

Cleansing is useful for removing visible debris, excess slough, exudate, or any remaining dressing material.
Gently irrigating the ulcer and surrounding skin using non-woven sterile swabs.
Reviewing whether debridement (removal of necrotic, devitalized, sloughy, or infected tissue) is appropriate.

Question 3

Managing pain on ulcers

Answer 3

Prescribe analgesia as needed

Ensure a person with expertise in wound management is involved in the person’s care (such as a district, palliative or tissue viability nurse) to select an appropriate dressing and, where possible, ensure the frequency of dressing changes is minimized.
Ensure administration of a breakthrough dose of short-acting opioid analgesia at least 30 minutes before a dressing change where possible. For more information, see the section on the Management of breakthrough pain in the CKS topic on Palliative cancer care - pain.
In discussion with a palliative care specialist consider the option of topically applied opioids for ulcerating wounds.

Question 4

How should I manage suspected infection?

Answer 4

Make a diagnosis of infection based on clinical symptoms and signs. Check for:
Fever or malaise, rigors or tachycardia.
Wound breakdown, abscess, or cellulitis.
Pocketing in the wound (pits or indents at sites in the wound bed).
Increased or altered appearance of exudate, increased pain at the site, or the presence of odour.
If infection is suspected, cleanse the surface, then take a swab
Assess whether ulcer debridement is appropriate
Ensure an appropriate dressing is used with an optimum frequency of dressing change
If an antibiotics is indicated due to suspected infection or surrounding cellulitis