Malignant Fungating Wounds in Locally Aggressive Cutaneous Squamous Cell Carcinoma - A Case Series

Sep 23, 2026

Uploaded by Jake

Despite surgical removal as first-line therapy, high-risk cutaneous squamous cell carcinoma (SCC) management remains difficult and inconsistent, partly because complications from less common secondary bacterial infections are underreported. The skin is the first defense against pathogens, yet locally aggressive cancers increase susceptibility via lesions and immunosuppression from chemotherapy, surgery, immunotherapy, and transplantation. Malignant fungating wounds (MFWs) can mimic abscesses and infections, further obscuring care. Two immunocompromised patients with locally aggressive SCC and MFWs had extensive tumor invasion, chronic infection, and multidrug-resistant Pseudomonas aeruginosa, underscoring treatment complexity.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Introduction

Cutaneous squamous cell carcinoma overview

Risk factors and precursor lesions

Diagnosis and treatment approaches

Clinical manifestations and infection-related complications

Review began 03/03/2025 Review ended 03/23/2025 Published 03/24/2025 © Copyright 2025 Zieneldien et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.81114 Open Access Case Report Malignant Fungating Wounds in Locally Aggressive Cutaneous Squamous Cell Carcinoma: A Case Series Tarek Zieneldien 1, Holly Lam 2, Sophia Ma 1 , Janice Kim 3, Ammar Mattar 4 , John Greene 5 1. Medicine, Johns Hopkins University School of Medicine, Baltimore, USA 2. Medicine, Morsani College of Medicine, University of South Florida, Tampa, USA 3. Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, USA 4. Vascular Surgery, Edward Via College of Osteopathic Medicine, Auburn, USA 5. Internal Medicine, Moffitt Cancer Center, Tampa, USA Corresponding author: John Greene, [john.greene@moffitt.org](john.greene@moffitt.org) Abstract Despite surgical removal being considered the first-line treatment, managing high-risk squamous cell carcinoma (SCC) cases remains challenging and lacks uniformity as associated complications of less common secondary bacterial infections are underreported. The skin, as well as its appendages, constitute the first line of defense against infectious pathogens. In patients with locally aggressive skin cancers, susceptibility to infectious microorganisms is elevated due to skin lesions and immunosuppression resulting from chemotherapy, surgery, immunotherapy, and stem cell transplantation. Furthermore, immunosuppressed patient populations, when infected, often have extended disease duration and heightened disease burden. Malignant fungating wounds (MFWs), cancerous lesions that typically occur during the terminal stages of a patient’s illness when tumors infiltrate the skin and surrounding tissue, may further complicate cases as they often can be misdiagnosed as abscesses or infections. Due to this, we sought to thoroughly characterize the disease progression, treatment efficacy, and risk factors of two patients with locally aggressive SCCs afflicted with MFWs and secondary Pseudomonas aeruginosa (P. aeruginosa) infections. We report two cases of cutaneous SCC (cSCC) in immunocompromised patients, one with HIV and the other a lung transplant recipient on chronic immunosuppression. Both cases were complicated by extensive tumor invasion, chronic infection, and multidrug-resistant P. aeruginosa. These cases highlight the aggressive nature of cSCC in immunocompromised individuals and the complexities of balancing oncologic treatment, palliative care, and infectious disease management. Categories: Dermatology, Palliative Care, Oncology Keywords: immunosuppression, malignant fungating wounds, palliative care, squamous cell carcinoma, supportive care Introduction Cutaneous squamous cell carcinoma (cSCC) is a common keratinocyte-derived malignancy that arises from the epidermal layer of the skin. It is the second most prevalent type of skin cancer in the United States, following basal cell carcinoma [1] . cSCC is most frequently diagnosed in white patients aged 70 years or older, with its prevalence increasing significantly with age [2,3] . While cSCC generally occurs at a higher rate in men than women, studies indicate that men more commonly develop cSCC on the ears, scalp, and neck whereas women are more likely to develop it on the lower limbs [2,3] . Key risk factors include ultraviolet (UV) light exposure, genetic conditions, and lighter skin tones [3,4] . Immunosuppression is another wellestablished factor as patients with hematological malignancies, those taking immunosuppressants, and transplant recipients have a higher risk of developing cSCC and face a greater likelihood of metastasis [4,5] . Environmental factors such as arsenic, polycyclic ar

FAQs

Why is managing high-risk cutaneous SCC challenging in this context?

High-risk cases lack uniformity because associated complications from less common secondary bacterial infections are underreported, making management harder to standardize.

What role do malignant fungating wounds (MFWs) play in locally aggressive SCC?

MFWs are cancerous lesions that can occur in terminal disease and are often misdiagnosed as abscesses or infections, complicating recognition and treatment.

What infections and patient conditions are highlighted in the two case reports?

Both cases involved immunocompromised patients and secondary Pseudomonas aeruginosa infections: one with HIV and one a lung transplant recipient under chronic immunosuppression.

Sep 23, 2026

Uploaded by Jake