Local Management of Malignant and Unresectable Fungating Wounds: PEBO Assessment

Malignant fungating wounds (MFWs) represent a major problem for public health. The most common symptoms associated with MFWs are pain, exudate, bleeding and odor. The aim of the study was to optimize the local management and dressing of MFWs. We developed a standardized 4- step approach to MFWs based on Pain, Exudate, Bleeding and Odor management in a case series of 24 patients: we call this the PEBO approach. We analyzed etiologies, localization, Quality of Life (QoL), pain and clinical signs and symptoms. We assessed the ulcers at baseline, after two weeks and after one month. In our study, most patients showed an improvement in the QoL using PEBO approach, although some experienced a deterioration in their general clinical conditions. Non-cytolesive cleansing, atraumatic dressings were applied to allow pain relief. Non-adherent dressings were combined with a secondary dressing in the case of exudate. Achieving hemostasis with dressing or medication is a priority in MFW management. Antibacterial dressings and odor absorbent dressings were used for odor absorption. Surgical debridement, adherent dressing and occlusive dressings were avoided. Dressing changes were programmed twice a week for four weeks. PEBO simplified the complex aspects of this type of ulcer, and could help physicians, nurses, and also the rest of the team, including the patients themselves and their family, in the multidisciplinary palliative care of MFWs.

Plantar Melanoma: An Investigation of Its Incidence

Melanoma accounts for more than 100,000 new cancer cases each year, and a minority (3%-15%) involve the foot and ankle. Case studies and isolated data set analyses report infrequent plantar melanomas, with these tumors more commonly encountered in non-whites. The absolute incidence of plantar melanoma is approximately the same in all races, but it is a more common type of cutaneous melanoma in non-white populations. Plantar melanoma is more prevalent in women, potentially a result of increased inflammation from uncomfortable shoes. When presenting on the plantar surface of the foot, features atypical of classic cutaneous melanoma are often present.

A rare case of acral amelanotic melanoma, nodular type

Amelanotic melanoma is a rare melanoma subtype, and it is even more rare when it occurs at an acral site. We here present a case of a nodular amelanotic acral melanoma (NAAM) occurring on the heel of an 83-year old female. It presented as an ulcerated pink nodular growth on the heel, which clinically mimicked other nodular non-pigmented lesions, causing a delay in diagnosis until it was biopsied. This case is a demonstration of the critical importance to include NAAM in the differential diagnosis of nodular non-pigmented skin lesions as to avoid delay in diagnosis and disease progression, in which early detection can provide the most modifiable prognostic factor.

Acral Amelanotic Melanoma Mimicking a Non-Healing Arterial Ulcer

Acral melanomas contribute to approximately 2-3% of melanomas but are commonly misdiagnosed due to their rarity, subtlety at onset and tendency to display amelanotic features. This case report describes a 70-year-old male with an amelanotic melanoma misdiagnosed as a non-healing arterial ulcer. Histopathology demonstrated a Breslow 2.3 mm, Clark level IV acral lentiginous melanoma, which was definitively managed with surgical intervention. This case report highlights the importance of considering melanoma in the differential diagnosis of non-healing ulcers.