Skin ulcers may occur with various cancers. The treatment of each type of cancer can vary and may include chemotherapy, radiotherapy, surgery, etc. It is beyond the scope of this leaflet to discuss how each type of cancer is treated. This leaflet just discusses the care of the skin ulcer itself.
What is a skin ulcer?
A skin ulcer occurs where an area of skin has broken down and you can see what lies underneath it (the underlying tissue). There are various causes of skin ulcers. One cause of a skin ulcer is when a cancerous (malignant) tumour occurs on, or just below, the skin surface. A skin ulcer caused by a cancerous tumour often has a discharge, may bleed, may become infected and may cause an unpleasant smell.
Cleaning the ulcer
This is usually best done with plenty of warm tap water. A nurse can do this when a dressing is changed. For some people, a shower may be easiest. Antiseptic washes are not usually used, as these may be harmful to the tissues and may delay healing.
Dressing the ulcer
The type of dressing chosen depends on various factors. For example, how moist the ulcer is, where the ulcer is, how deep the ulcer is and the amount of discharge. Some dressings are good at absorbing discharge. However, if there is little discharge, a dressing is used which has a low ability to take in and hold liquid (this is known as 'absorbency') so as not to dry out the wound. If the ulcer tends to bleed, a dressing containing a material called an alginate may help to control this.
If the ulcer has an unpleasant smell
- Special charcoal dressings may be used to absorb unpleasant smells. The charcoal fibres trap the gas molecules which cause the smell. However, frequent dressing changes may be needed, as charcoal dressings do not work so well if they become wet with discharge.
- Metronidazole tablets may also be prescribed to reduce smell. This antibiotic kills germs (bacteria) that commonly occur in skin ulcers. It is the bacteria that cause the smell by the gases that they make. You can take metronidazole tablets long-term if necessary. Note: some people feel sick or are sick (vomit) if they drink alcohol whilst taking metronidazole. Therefore, it is best not to have alcoholic drinks if you take metronidazole.
- Metronidazole ointment is an alternative if tablets are not suitable. It is applied once or twice a day and covered with a dressing.
- Perfumes or perfumed talc are not usually helpful. This is because the smell of the perfume often becomes associated with the unpleasant smell.
If the ulcer is painful
Tell your doctor or nurse if you have pain from the ulcer. Painkillers will usually help. If dressing the ulcer is painful, you can take a strong painkiller 30-60 minutes before dressing changes. If you are already taking painkillers, your doctor may advise a 'top-up' dose before each dressing change. Treatment for the cancer, such as chemotherapy or radiotherapy, may not only help to shrink the ulcer but also help to reduce the pain.
Further reading and references
Palliative care - malignant skin ulcer; NICE CKS, July 2015 (UK access only)
Recommendations for the Care of Patients with Malignant Fungating Wounds; European Oncology Nursing Society (EONS), 2015
Wallingford SC, Olsen CM, Plasmeijer E, et al; Skin cancer arising in scars: a systematic review. Dermatol Surg. 2011 Sep37(9):1239-44. doi: 10.1111/j.1524-4725.2011.02060.x. Epub 2011 Jun 2.
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