Description

A 60-year-old female with no previous medical history presented with progressive left sided weakness. Examination demonstrated a large, fungating chest wall mass with mucopurulent drainage and necrotic odor. The patient stated this lesion was worsening for multiple years and was associated with a 90-pound weight loss; however, she was hesitant to seek medical care until the onset of weakness. Comprehensive imaging, biopsy, and tissue analysis revealed the wound was consistent with fungating triple-negative breast adenocarcinoma with lung and frontal lobe metastasis (Figure 1).

Figure 1: Fungating breast mass on chest wall demonstrating mucopurulent drainage.

While breast cancer is the most common non-skin malignancy in women, only a subset of 2-5% of locally advanced breast cancers present with a fungating mass as seen in this patient [1]. For patients without known malignancy, such skin lesions involve a broad differential diagnosis, including chronic infection, medication effect, auto-immunity, and malignancy [2]. With the presence of distal metastases, this cancer was considered to be stage IV. Treatment options generally include palliative radiation and chemotherapy with surgical reconstruction of the necrotic chest wall for pain control and infection prevention [1,3,4]. While these therapies have shown efficacy in improving pain and short-term quality of life, long-term wound care challenges remain persistent due to the often extensive soft-tissue dissemination. Given that fungating masses typically indicate a late presentation and presence of likely distal metastasis, survival rates for these patients remain low [5].

Declarations

Conflicts of interest and disclosures: The authors deny any conflict of interest associated with this publication. The authors deny any financial disclosures. Patient consent for image capturing for publication was obtained prior to submission.

Funding: None.

References

1. Rupert KL, Fehl AJ. A Patient-Centered Approach for the Treatment of Fungating Breast Wounds. J Adv Pract Oncol. 2020; 11: 503-510.
2. Morton LM, Phillips TJ. Wound healing and treating wounds: Differential diagnosis and evaluation of chronic wounds. J Am Acad Dermatol. 2016; 74: 589-606.
3. Sood A, Daniali LN, Rezzadeh KS, Lee ES, Keith J, et al. Management and Reconstruction in the Breast Cancer Patient With a Fungating T4b Tumor. Eplasty. 2015; 15: e39. Published 2015 Sep 9.
4. Chakrabarti D, Verma M, Kukreja D, Shukla M, Bhatt MLB, et al. Palliative chest wall radiotherapy for a fungating and bleeding metastatic breast cancer: Quality of life beyond cure. BMJ Case Rep. 2021; 14: e243722.
5. Iqbal J, Ginsburg O, Rochon PA, Sun P, Narod SA, et al. Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States [published correction appears in JAMA. 2015; 313: 2287. JAMA. 2015; 313: 165-173.