Mapeamento de tratamentos tópicos e sistêmicos em pessoas com Miíase em feridas neoplásicas malignas cutâneas: revisão de Escopo

Abstract

Introduction: Cutaneous malignant neoplastic wounds (CMNWs), which represent a breakdown in skin integrity due to the growth of malignant tumors, pose a significant challenge in oncology nursing care. These chronic lesions are frequently associated with breast, head and neck, and skin cancers and are common in patients receiving palliative care (PC). CMNWs cause frequent and intense discomfort, characterized primarily by abundant exudate, bleeding, pain, itching, and unpleasant odors, negatively impacting patients' quality of life. In addition to these symptoms, the lesions can be parasitized by larvae, a condition called myiasis, which is the invasion of larvae of different genera of flies into human tissue. Hospital infestation by myiasis is common in tropical countries. Objectives: The main objective of this study was to map topical and systemic treatments for people with myiasis present in cutaneous malignant neoplastic wounds. Method: This is a scoping review, reported according to the PRISMA-ScR recommendations and conducted according to the Joanna Briggs Institute manual. The guiding question was formulated using the PCC strategy (Population, Concept, and Context), focusing on patients with FNMC (Population), topical and/or systemic treatments (Concept), and myiasis infection (Context). Searches were conducted in seven electronic databases (Cochrane, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science) and gray literature (Google Scholar, Pro-Quest), on January 20, 2025. Results: The initial searches resulted in 212 references. After removing duplicates and applying the two-phase selection criteria, the final sample consisted of 16 studies. Most studies were produced in Brazil, with a predominant methodological design of case reports. The primary treatment for myiasis was ivermectin, identified in 9 of the included studies, with various routes and dosages (oral and topical, ranging from a single dose of 200 mg/kg to 12 mg/kg for 3 days). In addition to ivermectin, antibiotics were frequently mentioned as systemic treatment, while topical treatments included local antiseptics, saline solution, chlorhexidine, and turpentine oil. A crucial component of myiasis management in FNMC was identified as debridement (surgical or mechanical) and physical/manual larval removal. Conclusion: This scoping review achieved its objective of mapping treatments for myiasis in FNMC, providing an overview of current practices. However, analysis of the results revealed gaps in detailed information regarding patients' socioeconomic profile, specific wound characteristics, and treatment history, reflecting the nature of the available literature (predominance of case reports) and methodological heterogeneity. The mapping highlights the importance of ivermectin and larval removal in the management of this complication and points to the need for future studies with more robust designs to better evaluate efficacy and optimize care for this specific population.