An Alternative Approach to the Management of Wounds Secondary to Diagnosis or Treatment of Skin Cancers

Introduction: Skin cancer ranks as the most common form of cancer in the United States with an estimated 1 in 5 individuals developing a form of skin cancer in their lifetime1-3. Actinic keratosis (AK) carries a 0.025-16% risk of progression to squamous cell carcinoma (SCC)4. When combined with basal cell carcinoma (BCC), an estimated 5.4 million cases of SCC and BCC are diagnosed in the US each year5. Diagnosis for AK, SCC and BCC require a biopsy that can progress to a non-healing wound and one common treatment for both BCC and SCC is The Mohs procedure (MP) that is sometimes left to heal by secondary intent (SI). This case series presents an alternative approach to managing post-Mohs wounds as well as a non-healing wound resulting after a biopsy. These patients were treated with weekly debridement, followed by application of a five-layer native type I collagen extracellular matrix (ECM) with polyhexamethylene biguanide (PHMB) antimicrobial barrier (PCMP-XT)(a) followed by weekly application of a fresh hypothermically stored amniotic membrane (HSAM)(b) wound covering.Methods: A case series of 5 wounds on 4 patients with multiple comorbidities having undergone either post-Mohs surgery or a biopsy resulting in a non-healing wound is presented. Patients received weekly debridement, standard of care (SOC) for their wound type, and application of PCMP-XT, followed by subsequent application of HSAM. One patient required arterial ultrasound for diagnostic evaluation followed by an endovascular procedure.Results: All patients in this case series were female, with a mean age of 87.4 yrs old. Four patients underwent post-Mohs surgery, two for SCC and two for BCC. One patient presented with a non-healing wound after a biopsy for AK. Mean baseline wound size was 3.88 cm2. All 5 wounds closed, with an average time to wound closure of 6.74 weeks. All patients received an average of 3.8 PCMP-XT applications and an average of 2 HSAM applications.Conclusions: The results of this case series suggest that PCMP-XT application, followed by subsequent application of HSAM as a wound covering, may provide an alternative approach to managing non-healing and post-Mohs wounds left to heal by secondary intent.