Local Management of Malignant and Unresectable Fungating Wounds: PEBO Assessment

Abstract

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.

Non‐invasive imaging techniques in presurgical margin assessment of basal cell carcinoma: Current evidence

“…Hedgehog inhibitors (vismodegib and sonidegib) have shown good results in locally advanced and metastatic BCC 11 , 12 . Recently, cemiplimab (programmed death receptor 1 inhibitor) was approved as a second treatment option in resistant cases 13 . In not responsive and untreatable ulcerative BCC, the local palliative approach is useful and complex aspects of this type of lesions have been recently summarized by the acronym PEBO (pain, exudate, bleeding and odour) 14 .…”

“…11 , 12 Recently, cemiplimab (programmed death receptor 1 inhibitor) was approved as a second treatment option in resistant cases. 13 In not responsive and untreatable ulcerative BCC, the local palliative approach is useful and complex aspects of this type of lesions have been recently summarized by the acronym PEBO (pain, exudate, bleeding and odour). 14 Certainly, progress has been made in the management of BCC in recent years, but current therapies can partially control advanced forms with still high risks of recurrence.…”