GPAtlas🧭 When to suspect
A malignant fungating wound (MFW) – also called a malignant skin ulcer or ulcerating cancer wound – develops when malignant cells infiltrate and break through the skin, producing an ulcerating or proliferative (fungating) lesion. It affects approximately 5–10% of people with advanced or metastatic cancer, most often arising from breast (chest wall), head and neck, melanoma, or soft-tissue sarcoma. Most appear in advanced disease, frequently in the last 6–12 months of life.
The defining principle is that healing is rarely achievable, so management targets symptom control and quality of life (QoL), not cure. The task in primary care is to assess and treat the cardinal wound symptoms – exudate, malodour, bleeding, pain and pruritus – together with their substantial psychosocial impact, while coordinating district nursing, tissue viability and specialist palliative care.
Suspect an MFW in any patient with known cancer whose skin lesion is breaking down. Occasionally a fungating mass (classically a neglected breast cancer) is the first presentation of an undiagnosed malignancy, where biopsy is needed to confirm the diagnosis.
| Cardinal symptom | Why it matters |
|---|---|
| Exudate | Often copious; soaks through dressings and clothing (strike-through), macerates surrounding skin, and drives significant protein and fluid loss and embarrassment. |
| Malodour | Arises from anaerobic colonisation and necrotic tissue; frequently the most socially distressing symptom, driving shame and isolation. |
| Bleeding | Friable, abnormally vascular tumour tissue bleeds easily – from oozing at dressing changes to catastrophic haemorrhage. |
| Pain | Background pain (nociceptive and/or neuropathic) plus incident pain provoked by dressing changes. |
| Pruritus | Itching in and around the wound; often under-recognised and difficult to relieve. |
| Psychosocial impact | Body-image disturbance, shame, social withdrawal and considerable carer strain – assess in every patient. |
Source: Scottish Palliative Care Guidelines · Wounds UK
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