文章 APA O'Neill, L., Nelson, Z., Ahmad, N., Fisher, A. H., Denton, A., Renzi Jr, M.

M., Fraimow, H. S.,

& Stanisce, L. (2022). Malignant fungating wounds of the head and neck: Management and
antibiotic stewardship. OTO Open, 6(1), 2473974X211073306.
https://doi.org/10.1177/2473974X211073306
內文 APA O'Neill et al., 2022
作者/年代 (O'Neill et al., 2022)
研究目的
研究方法
研究結果
整合
可以運用 01. Malignant fungating wounds (MFWs) are unfortunate and underreported
的地方 manifestations of some advanced head and neck cancers. The management of MFWs
is complex and challenging. MFWs are often mistaken for infectious
processes/abscesses and treated indiscriminately with oral or intravenous antibiotics.
Our aim is to promote awareness of MFWs and provide education on their
management. We summarize their cost-effective and evidence-based therapies and
highlight antibiotic stewardship with respect to their management.
02. 惡性蕈狀傷口（MFW）是一些晚期頭頸癌的不幸且未被充分報告的表現。家庭
傭工的管理既複雜又具挑戰性。MFW 常被誤認為是感染過程/膿腫，並且不加
區別地使用口服或靜脈注射抗生素進行治療。我們的目標是提高小家庭工人的
意識並提供有關其管理的教育。我們總結了它們具有成本效益和基於證據的療
法，並強調了與其管理有關的抗生素管理(O'Neill et al., 2022)。
03. Malignant tumors of the head and neck (eg, squamous cell and basal cell carcinoma)
with cutaneous and subcutaneous involvement are very often unsightly and associated
with fetid odor, drainage, bleeding, and sloughing. It is not surprising that tumors that
breach the skin and create a malignant fungating wound (MFW) would be confused
for an infection or abscess. As a result, these malignant tumors are subject to a variety
of cognitive biases associated with medical decision making, including premature
closure, representativeness restraint, Sutton’s slip, and anchoring.1-5 This holds
particularly true for tumors that demonstrate aggressive and advanced local
involvement. These tumors can present with a fungating and ulcerative appearance
and are oftentimes accompanied by excoriation of the surrounding skin, intense
malodor, profuse fibrinous or purulent exudate, bleeding, and pain.6-9 These clinical
findings may be misleading to first-line providers, who are accustomed to treating
common infections such as abscesses or cellulitis, which can have a similar
appearance to these particular tumors.
04. 涉及皮膚和皮下的頭頸部惡性腫瘤（例如鱗狀細胞癌和基底細胞癌）通常不美
觀，並伴隨惡臭、引流、出血和腐肉。毫不奇怪，突破皮膚並產生惡性蕈狀傷
口 (MFW) 的腫瘤會被誤認為是感染或膿腫。因此，這些惡性腫瘤容易受到與
醫療決策相關的各種認知偏差的影響，包括過早閉合、代表性限制、薩頓滑移
和錨定。1 - 5 對於表現出侵襲性和高級局部受累的腫瘤尤其如此。這些腫瘤可
 表現為真菌性和潰瘍性外觀，並且常伴隨周圍皮膚的抓痕、強烈的惡臭、大量
纖維蛋白或膿性滲出物、出血和疼痛。6 - 9 這些臨床發現可能會誤導第一線醫
療服務提供者，他們習慣於治療膿腫或蜂窩性組織炎等常見感染，這些感染可
能與這些特定腫瘤具有相似的外觀(O'Neill et al., 2022)。
05. MFWs can occur in primary, recurrent, and metastatic cancer settings. Unfortunately,
MFWs are difficult to conceal in the head and neck region; they draw ready attention;
and they can cause significant psychosocial dysfunction for the patients and distress
and anxiety for their family members or caregivers. MFWs in the head and neck
region also pose unique management challenges because they can readily affect the
form and function of important structures and organs within this relatively compact
surface area of the body. Because of a lack of awareness and readily available
resources for guiding therapy, first-line providers often adopt a “trial and error”
approach to the management of MFWs.
06. MFW 可能發生在原發性、復發性和轉移性癌症。不幸的是，MFW 很難隱藏在
頭部和頸部區域；它們引起了人們的注意；它們可能會給患者帶來嚴重的心理
社會功能障礙，並給他們的家人或照護者帶來痛苦和焦慮。頭部和頸部區域的
MFW 也帶來了獨特的管理挑戰，因為它們很容易影響身體相對緊湊的表面積內
重要結構和器官的形式和功能。由於缺乏指導治療的認識和現成資源，第一線
醫療服務提供者經常採用「試錯」方法來管理 MFW(O'Neill et al., 2022)。
07. MFWs are the result of cancer cells infiltrating and invading the dermis and epidermis
and manifesting as an exophytic and/or ulcerative necrotic lesion. Regions of tissue
hypoxia and necrosis ensue as a result of tumor proliferation, areas of variable
vascularity, and tumor-related factors and by-products, as well as recruitment of
inflammatory cells.12-14 This results in a tumor/wound with a common coexistent
appearance: exophytic, fungating, necrotic, ulcerative, purulent, exudative, and
bleeding. The most frequent sites for presentation are the breast (49%), neck (21%),
chest (18%), and head (13%).10,15 These tumors/wounds frequently exhibit
inflammation and discoloration beyond the wound borders, due to the presence of the
underlying tumor and local tissue invasion. In more advanced tumors, large areas of
necrosis may cause significant anatomic disfigurement and patient distress.16
Debilitating pain, pruritus, exudate, and bleeding associated with these tumors may
affect activities of daily living and diminish patient quality of life.17 MFWs are often
malodorous, having been described as “rotting sulfide” or “cheese and vomit.”18
Anaerobic bacteria that reside in necrotic tissue generate volatile agents such as
hydrogen sulfide. Despite bacterial colonization, there is no evidence that these odor-
producing bacteria result in bacteremia or septicemia. One study analyzed 32 patients
with breast cancer and fungating wounds and reported no systemic infections despite
evidence of colonization in 78% of these tumors.
08. MFW 是癌細胞浸潤和侵入真皮和表皮的結果，表現為外生性和/或潰瘍性壞死
病變。由於腫瘤增殖、血管分佈變化的區域、腫瘤相關因子和副產物以及發炎
細胞的募集，導致組織缺氧和壞死。12 - 14 這會導致腫瘤/傷口有共同的共存外
觀：外生性、真菌性、壞死性、潰瘍性、化膿性、滲出性和出血性。最常出現
的部位是乳房（49%）、頸部（21%）、胸部（18%）和頭部（13%）。10 , 15
由於潛在腫瘤和局部組織侵襲的存在，這些腫瘤/傷口經常表現出傷口邊界以外
的發炎和變色。在較晚期的腫瘤中，大面積壞死可能會導致嚴重的解剖缺陷和
患者痛苦。16 與這些腫瘤相關的衰弱性疼痛、搔癢、滲出物和出血可能會影響
日常生活活動並降低患者的生活品質。17 MFW 通常有惡臭，被描述為「腐爛
的硫化物」或「起司和嘔吐物」。18 壞死組織中的厭氧細菌會產生硫化氫等揮
發性物質。儘管有細菌定植，但沒有證據顯示這些產生氣味的細菌會導致菌血
症或敗血症。一項研究分析了 32 名患有蕈狀傷口的乳癌患者，結果顯示儘管有
證據表明 78% 的腫瘤存在定植，但並未出現全身性感染(O'Neill et al., 2022)。