Malignant Skin Ulcers

What is a skin ulcer?

A skin ulcer is where an area of skin has broken down and you can see the underlying tissue. There are various causes of skin ulcers. One cause of a skin ulcer is when a cancerous 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. For example, some dressings are good at absorbing discharge. However, if there is little discharge, a dressing is used which has a low 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 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 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.