Staging of malignant cutaneous wounds: a pilot study.
OBJECTIVE
To determine the color, size, hydration, and general appearance of malignant cutaneous wounds (MCWs); the effectiveness of using digital imagery to quantify wound characteristics; and the feasibility of an MCW staging system.


METHODS
Descriptive pilot study.


METHODS
A university-affiliated, comprehensive cancer center.


METHODS
Assessment of each subject's wound (N = 13) using the Hopkins Wound Assessment Tool (HWAT) and digital analysis of photographs. Development of an MCW staging system from grouping and classifying the assessment data. A panel of experts used the assessment data and MCW staging system to determine each subject's wound stage and the feasibility of a staging system. Visual HWAT data and digital photographic assessment data were compared for consistency in size, color, and hydration status.


METHODS
Characteristics and stages of MCW; digital imagery.


RESULTS
Investigators identified four stages of MCW using the wound characteristics. Digitally assessed wound measurements of size, color, and hydration status were consistent, reflecting the ability of this method to accurately capture malignant wound characteristics.


CONCLUSIONS
An MCW staging system is feasible. Wound color, hydration status, the absence or presence of nodules, drainage, pain, odor, and tunneling indicate the stage of malignant wound progression. The two stages identified are distinctly different from pressure or diabetic wound progression. Stage 1N is characterized by fibrous desmoplasia (hard fibrous nodule) of cancer metastasis, and stage 4 is characterized by destruction of the basement membrane. Data comparisons indicate that digital assessment has potential for more accurately recording wound assessment indices.


CONCLUSIONS
Nurses can improve their assessment and management of a patient's MCW by understanding the wounds' stages and using a digital imaging protocol. Further research is needed to establish the reliability and validity of the MCW staging system and the digital assessment and quantification protocol.
Oncology Nursing Department, Johns Hopkins Oncology Center, Baltimore, MD.
M E
ME
Haisfield-Wolfe
L M
LM
Baxendale-Cox
D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010781:Photography / Q000379:methods; D010865:Pilot Projects; D012878:Skin Neoplasms / Q000473:pathology* / Q000556:secondary