INTEGRATIVE REVIEW

NURSING ROLE IN PALLIATIVE CARE FOR PATIENTS WITH NEOPLASTIC WOUNDS

ACTUACIÓN DE LA ENFERMERÍA EN LOS CUIDADOS PALIATIVOS A PACIENTES CON HERIDAS NEOPLÁSICAS

ATUAÇÃO DA ENFERMAGEM NA ASSISTÊNCIA PALIATIVA A PACIENTES COM FERIDAS NEOPLÁSICAS

https://doi.org/10.31011/reaid-2025-v.99-n.3-art.2583

Marcos Carvalho da Silva¹

Andreza de Oliveira Ribeiro²

Sthefani Santana dos Santos³

Monyse Ribeiro Souza⁴

Josefa Raianne Peixoto de Carvalho e Souza⁵

Matheus Henrique Santana Santos⁶

Kaique Maximo de Oliveira Carvalho⁷

¹Centro Universitário AGES (UNIAGES), Paripiranga-BA, Brazil. ORCID: https://orcid.org/0000-0003-1938-0077

²Centro Universitário AGES (UNIAGES), Paripiranga-BA, Brazil. ORCID: https://orcid.org/0009-0008-6518-8856

³Centro Universitário AGES (UNIAGES), Paripiranga-BA, Brazil. ORCID: https://orcid.org/0009-0001-0458-8353

⁴Centro Universitário AGES (UNIAGES), Paripiranga-BA, Brazil. ORCID: https://orcid.org/0009-0007-0120-3167

⁵Centro Universitário AGES (UNIAGES), Paripiranga-BA, Brazil. ORCID: https://orcid.org/0009-0006-0937-5804

⁶Centro Universitário AGES (UNIAGES), Paripiranga-BA, Brazil. ORCID: https://orcid.org/0009-0002-5253-4680

⁷Centro Universitário AGES (UNIAGES), Paripiranga-BA, Brazil. ORCID: https://orcid.org/0000-0002-1308-5459

Corresponding Author

Marcos Carvalho da Silva

Rua Papa Paulo VI, Simão Dias/SE, Brazil. CEP: 49480000, contact: +55 (79) 996068463, E-mail: marcostrtr4@gmail.com.

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ABSTRACT

Cancer is presented as a potentially fatal pathology, characterized by abnormal and uncontrolled cell multiplication, the infiltration of cancerous cells into tissues gives rise to chronic, non-healing wounds, whose symptoms include exudate, bleeding, pain, and odor, directly impacting the patient's biopsychosocial state. From this perspective, the general objective of this study is to analyze nursing care in the management of patients with malignant neoplastic wounds, addressing treatment strategies for symptom control, as well as identifying the main challenges and inappropriate practices reported in the literature. This research is an integrative literature review, conducted using the following electronic databases: Virtual Health Library (VHL), Scientific Electronic Library Online (SCIELO), Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database (BDENF), National Library of Medicine (PUBMED), and Medical Literature Analysis and Retrieval System Online (MEDLINE), with the following inclusion criteria: full scientific articles published between 2020 and 2025, available in Portuguese, English, and Spanish. The publications highlight the importance of nursing professionals in managing neoplastic wounds and the challenges and inappropriate practices present in the offered treatment strategies. In conclusion, the research reflects the importance of ongoing professional training for nurses, aiming to promote palliative care based on appropriate treatment according to the needs presented by the malignant neoplastic wound, thus ensuring the humanization of care.

Keywords: Nursing, Wounds and Injuries, Palliative Care.

RESUMEN

El cáncer se presenta como una patología potencialmente mortal, caracterizada por la multiplicación celular anormal e incontrolada, la infiltración de células cancerosas en los tejidos da origen a heridas crónicas que no cicatrizan, cuyas manifestaciones clínicas incluyen exudado, sangrado, dolor y mal olor, impactando directamente en el estado biopsicosocial del paciente. En esta perspectiva, el objetivo general de este estudio es analizar los cuidados de enfermería en el manejo de pacientes con heridas neoplásicas malignas, abordando las estrategias de tratamiento para el control de los síntomas, además de identificar los principales desafíos y conductas inadecuadas reportadas en la literatura. La investigación se trata de una revisión integrativa de la literatura, realizada a través del uso de las siguientes bases de datos electrónicas: Biblioteca Virtual en Salud (BVS), Scientific Electronic Library Online (SCIELO), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Base de Datos de Enfermería (BDENF), National Library of Medicine (PUBMED) y Medical Literature Analysis and Retrieval System Online (MEDLINE), con los siguientes criterios de inclusión: artículos científicos completos publicados entre 2020 y 2025, disponibles en portugués, inglés y español. Las publicaciones evidencian la importancia de la asistencia del profesional de enfermería en el manejo de las heridas neoplásicas y los desafíos y conductas inadecuadas presentes en las estrategias de tratamiento ofrecidas. En conclusión, la investigación refleja la importancia de la capacitación continua de los profesionales de enfermería, con el objetivo de promover una atención paliativa basada en el tratamiento adecuado según las necesidades presentadas por la herida neoplásica maligna, garantizando así la humanización del cuidado.

Palabras clave: Enfermería, Heridas y Lesiones, Cuidados Paliativos.

RESUMO

O câncer é apresentado como uma patologia potencialmente fatal, caracterizada pela multiplicação celular anormal e incontrolável, os infiltrados de células cancerígenas nos tecidos dão origem às lesões crônicas não cicatrizantes cuja sintomatologia apresenta exsudato, sangramento, dor e odor, impactando diretamente no estado biopsicossocial do paciente. Nesta perspectiva, o objetivo geral deste estudo visa analisar os cuidados de enfermagem no manejo de pacientes com feridas neoplásicas malignas, abordando as estratégias de tratamento para o controle dos sintomas, além de identificar os principais desafios e condutas inadequadas relatadas na literatura. A pesquisa trata-se de uma revisão integrativa da literatura, realizada por meio da utilização das seguintes bases eletrônicas de dados: Biblioteca Virtual de Saúde (BVS), Scientific Eletronic Library Online (SCIELO), Literatura Latino-Americana e do Caribe em ciências da Saúde (LILACS), Base de dados de Enfermagem (BDENF), National Library of Medicine (PUBMED) e Medical Literature Analysis and Retrivel System Online (MEDLINE, com os seguintes critérios de inclusão: artigos científicos completos no período de 2020 a 2025, disponíveis em Português, inglês e espanhol. As publicações evidenciam a importância da assistência do profissional enfermeiro no manejo das feridas neoplásicas e os desafios e condutas inadequadas presentes nas estratégias de tratamento oferecidas. Em conclusão, a pesquisa reflete a importância da capacitação continuada dos profissionais de enfermagem, visando a promoção de uma assistência paliativa pautada no tratamento adequado conforme as necessidades apresentadas na ferida neoplásica maligna, garantindo assim a humanização do cuidado.

Palavras-Chaves: Enfermagem, Ferimentos e Lesões, Cuidados Paliativos.

INTRODUCTION

Cancer is presented as a potentially fatal pathology, characterized by abnormal and uncontrollable cell proliferation, capable of infiltrating multiple tissues and organs. Cancerous neoplasms represent the second leading cause of death in adults and children. Although cancer treatment has undergone significant advances, the frequent presence of the idea of death still strongly accompanies the diagnosis of patients with cancer ^{(1, 2)}.

The conception of a cancer diagnosis is surrounded by a mix of emotions. While the affected patient must face the reality of their finitude, they also deal with the impact of their condition on their entire circle of friends. Furthermore, there is a tendency for the patient's psychological illness to progress, expressed by a lack of self-care, social isolation, feelings of rejection, and intense psychological and emotional overload ⁽³⁾.

Neoplastic wounds originate from the infiltration of cancer cells into the skin structure, consequently leading to a breakdown in skin tissue integrity and resulting in chronic, non-healing exophytic lesions known as fungal neoplastic wounds (NFW) ⁽⁴⁾. According to studies, the disorderly invasion of cells can lead to a reduction in tissue oxygen supply, culminating in the formation of necrotic tumor tissue. These specific conditions in the affected tissue promote odor formation, increase exudate and bleeding, and serve as a possible source of bacterial contamination ⁽⁵⁾.

From this perspective, palliative care emerges as a fundamental approach for the management of wounds that no longer respond to conventional treatments. It aims to alleviate the signs and symptoms caused by lesions that are now fixed and incurable, as well as to ensure quality of life, psychological support, and patient comfort ⁽⁶⁾. Furthermore, palliative care promotes physical comfort, emotional, psychological, and spiritual support, recognizing the need for humanized and holistic care for the affected patient ⁽³⁾.

The high complexity of care for patients with neoplastic wounds requires a humanized and interdisciplinary approach. In this context, nursing plays a fundamental role in clinical assessment, monitoring progress, prescribing appropriate dressings, and controlling the physical symptoms of the disease, such as pain reduction, exudate management, bleeding control, odor reduction, and prevention of potential infections ⁽⁷⁾.

Consequently, this research is justified by the need to broaden the discussion on palliative care provided by nursing professionals to patients with neoplastic wounds. The study will significantly contribute to the care provided by professionals, aiming to promote more humanized practices and strengthen existing knowledge in the field. Furthermore, the study will enable an increase in published scientific materials, given the lack of studies and standardized care protocols addressing this issue.

The objective of this study is to analyze nursing care in the management of patients with malignant neoplastic wounds, addressing treatment strategies for symptom control, in addition to identifying the main challenges and inappropriate behaviors reported in the literature.

METHODS

This is an integrative literature review with a qualitative approach that allows for the presentation of scientific evidence on the topic addressed through a synthesized and standardized search method. The method allows for a bibliographic survey of studies with a preliminary raw base and a sequence of application of search filters to form a convergent database, using exploratory reading as a method of data analysis and prioritization ⁽⁸⁾.

This study was conducted according to the following steps: 1) Establishment of the guiding research question; 2) Establishment of inclusion and exclusion criteria; 3) Collection of publications from electronic databases; 4) Analysis of the studies included in the research; 5) Interpretation of the results obtained; 6) Presentation of the review (Souza; Silva; Carvalho, 2010).

The guiding question was developed using a tool with the acronym PICO, where P (Patients/Problem): "Patients with neoplastic wounds"; I (Intervention): "nursing performance in palliative care"; C (Comparison): "no intervention"; O (Outcome): "quality of life and comfort." Therefore, the following research question was established: What palliative care strategies are used by nurses in the care of patients with neoplastic wounds?

The main electronic databases used were: Virtual Health Library (VHL), Scientific Electronic Library Online (SCIELO), Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database (BDENF), National Library of Medicine (PUBMED), Medical Literature Analysis and Retrieval System Online (MEDLINE).

The use of descriptors in health sciences (DECS) associated with Medical Subject Headings (MeSH) were used to screen academic articles in the databases, according to the following search expression in Portuguese: (“Neoplasias” OR “Wounds and injuries” OR “Wounds neoplastic”) AND (“Palliative Care”) AND (“Enfermagem” OR “Cuidados de Enfermagem” OR “Enfermagem Oncológica”) and English: (“Wounds and Injuries” OR “Neoplastic wounds” OR “Malignant wounds” OR “Malignant fungating wound”) AND (“Nursing” OR “Nursing care” OR “Oncology Nursing”). The search expression used in the electronic databases is expressed in (Table 1).

Table 1 - Search expression used to stratify studies.

DATABASE	SEARCH EXPRESSION
SciELO	(“Neoplasias” OR “Ferimentos e lesões” OR “Feridas neoplásicas”) AND (“Cuidados Paliativos”) AND (“Enfermagem” OR “Cuidados de Enfermagem” OR “Enfermagem Oncológica”)
LILACS
BDENF
MEDLINE	("Wounds and Injuries" OR "Neoplastic wounds" OR "Malignant wounds" OR "Malignant fungating wound") AND ("Nursing" OR "Nursing care" OR "Oncology Nursing")

Source: Prepared by the authors, 2025.

The primary studies were collected from July 4th to 5th, 2025. The following inclusion criteria were used: articles published in Portuguese, English, or Spanish; free articles available in full; articles with a five-year time frame (January 2020 to December 2024); publications with a qualitative, quantitative, or integrative/systematic/scope/cross-sectional review design that addressed nursing care in the symptomatic management of neoplastic wounds (odor, bleeding, exudate, odor), as well as the challenges experienced and imprudent practices performed in care practice.

The exclusion criteria were incomplete publications, articles published in conference proceedings, books, editorials, simple abstracts, dissertations, or doctoral theses; publications that diverged from the thematic focus of the research (non-neoplastic wounds); and those published in a language and timeframe different from that determined in the research.

RESULTS

The identification stage allowed the collection of a total of 6,685 scientific publications from the databases: 6,244 from MEDLINE, 198 from LILACS, 178 from BDENF, and 65 from the SciELO collection. Using the established inclusion and exclusion criteria, a total of 6,295 studies were eliminated, as well as 52 duplicates. This left 338 articles, of which 226 articles are from MEDLINE, 52 articles from LILACS, 46 articles from BDENF, and 14 articles from the SciELO collection.

In the screening stage, 338 scientific articles were recorded. An abstract reading of the titles was performed, resulting in the exclusion of 272 studies for being unrelated to the topic, and 41 articles after reviewing the abstracts, resulting in the exclusion of 25 publications that were retained. Of the 25 studies selected for full-text review, 13 articles were eliminated, of which 11 presented divergent themes and 2 were dissertations.

Based on a comprehensive analysis of the studies evaluated for eligibility, the inclusion stage consisted of selecting 12 articles to comprise the integrative review, which is organized in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart, as highlighted in Figure 1.

Figure 1 – Flow of study selection for review according to databases, 2025.

Source: Prepared by the authors, 2025.

The final sample of this research has a total of twelve articles (100%), of which four articles (33.3%) were published in 2020, three articles (25%) were published in 2022, three articles (25%) were published in 2023, and two articles (16.7%) were published in 2024. Of these, four articles (33.3%) were published in MEDLINE, five articles (41.67%) were published in LILACS, and three articles (25%) were published in BDENF.

Of the twelve articles (100%), four (33.3%) were integrative reviews, one (8.3%) was a descriptive study, two (16.7%) was a scoping review, two (16.7%) were retrospective reviews, one (8.3%) was a qualitative study, one (8.3%) was a cross-sectional study, and one (8.3%) was an observational study. The selected publications were arranged according to the following variables: author/year, title, journal, method, and results, as highlighted in (Table 2).

Table 2 – Summary of selected articles, 2025.

Author/year	Title	Journal	Method	Results
Lucena et al. 2020 ⁽³⁾	Scientific Evidence on Interventions for Palliative Care Patients With Wound: A Scoping Review	Rev Fun Care Online	Scoping review	The following aspects were analyzed: interventions related to care management; interventions related to wound care; interventions related to psychosocial and spiritual aspects.
Pramod et al. 2024 ⁽⁵⁾	A survey of UK nurses about their care of people with malignant fungating wounds	European Journal of Oncology Nursing	Cross-sectional study	Poor access to training and a lack of local guidelines related to oncological wound care were identified. Regarding the professionals' knowledge, it was assessed that 24 (22.2%) were very confident; 49 (45.4%) were confident; 25 (23.1%) were somewhat confident; and 10 (9.3%) had limited confidence.
Faria, Fuly. 2023 ⁽⁷⁾	Construction and validation of an instrument on neoplastic wound management for nurse training	Cogitare Enfermagem	Scoping review	The nurses' weaknesses in nursing care were observed in controlling neoplastic wound symptoms, in addition to a lack of skill and knowledge during wound management.
Dias et al. 2023 ⁽⁹⁾	Nursing care in the treatment of oncological wounds in women with breast cancer	Revista Enfermagem atual in derme	Integrative review	Three articles were selected that addressed the relevance of the correct use of dressing covers according to the stage of each injury and the lack of knowledge in the handling of injuries by nurses.
Silva, Conceição, 2020 ⁽¹⁰⁾	Palliative nursing care for patients with neoplastic wounds	Revista espaço para a saúde	Integrative review	Eight articles were selected that address the following themes: 1) symptomatology and nursing care for neoplastic wounds; 2) palliative care; 3) Nursing performance regarding psychosocial aspects; 4) continuing education regarding the care provided to patients with neoplastic wounds.
Nascimento et al. 2024 ⁽¹¹⁾	Palliative care for people with neoplastic wounds: perceptions and practices of the nursing team	Revista de Enfermagem da UPPI	Descriptive study	Some aspects emerged regarding the chosen theme: The care provided by the nursing team and the aspects that transcended this care, nursing performance in the management and evaluation of the neoplastic wound, as well as analysis of the professionals' emotions in the situation of palliative care.
Novais, Kaiser, Domingues. 2022 ⁽¹²⁾	Nursing care for people with malignant neoplastic wounds: An integrative review	Revista Enfermagem atual in derme	Integrative review	Twenty-three articles were found, 14 were excluded, leaving only 9 for critical analysis. In which the following symptoms were observed: pain, exudate, bleeding and odor, however, in less repetition: tissue necrosis and psychological aspects.
Nicodème et al. 2020 ⁽¹³⁾	Frequency and Management of Hemorrhagic Malignant Wounds: A Retrospective, Single-Center, Observational Study	Journal of Pain and Symptom Management	Retrospective review	Approximately ninety patients were analyzed, 74.4% female and 25.6% male with a previous history of CA, whose most evident symptoms were minor bleeding, major bleeding in malignant wounds and the presence of hemorrhage in 18.9% of patients, these hemorrhages were stopped with hemostatic dressing in 70.6% of cases.
Starace et al. 2022 ⁽¹⁴⁾	Management of malignant cutaneous wounds in oncologic patients	Supportive Care in Cancer	Retrospective review	Dressing management varied according to the characteristics of the patients and ulcers. The selected patients were 9 women and 2 men with an average age of 63 years.
Lima et al. 2022 ⁽¹⁵⁾	Care and family support for people with malignant neoplastic wounds at home	Estima	Qualitative study	Reports were obtained from family members who provided care to the patient and a lack of guidance to the family was noted, emphasizing the need for support from health professionals.
Oliveira et al. 2023 ⁽¹⁶⁾	Nursing guidelines for neoplastic wound care at hospital discharge: an integrative review	Revista Enfermagem atual in derme	Integrative review	Reports from family caregivers of patients with malignant neoplastic wounds were discussed, as well as the most evident complications in FNM.
Schmidt et al. 2020 ⁽¹⁷⁾	Knowledge of the nursing team about care for patients with neoplastic wounds	Revista brasileira de enfermagem	Observational study	Results obtained through the application of a questionnaire with specific questions about FNM, obtaining the following results: nursing technicians had a greater number of correct answers regarding care for the symptoms of the injury, while nurses had a greater frequency of correct answers on the subject of healing and cure of FNM.

Source: Prepared by the authors, 2025

DISCUSSION

Nursing care plays an essential role in the management of oncological wounds, as the profession is responsible for prescribing appropriate dressings, monitoring symptoms, providing emotional support, analyzing structural aspects, and monitoring the clinical progression of neoplastic lesions in patients undergoing palliative care ^(9,10).

According to studies, the most appropriate dressings are selected based on the symptomatic manifestations of neoplastic wounds. In a study conducted at a hospital specializing in high-complexity oncology in the interior of Minas Gerais (MG), the most common symptoms observed in these wounds were a foul odor (100%) of the cases analyzed, followed by excessive exudate (62.5%), intense pain (50%), continuous bleeding episodes (37.5%), and recurrent infections ⁽¹¹⁾.

For wounds with excessive exudate, bactericidal dressings such as alginate or polyurethane foam and hygiene with saline solution or polyhexanide solution (PHMB) were recommended ^(10,11,12). For foul-smelling wounds, 0.4% chlorhexidine and polyhexanide were used for cleaning, and 8% metronidazole was used in combination with activated charcoal and silver sulfadiazine ^(9,5). For bleeding, hemostatic dressings with non-adherent dressings, calcium alginate, cryotherapy, or irrigation with 0.9% saline solution and hemostatic agents (Surgicel) were used ^(3,12,13).

Proper management of neoplastic wounds requires technical and scientific knowledge, as well as humane practices to address the patient's emotional and psychological needs. The evidence gathered highlighted that pain control in oncological wounds remains a frequent challenge in nursing practice, highlighting the need to streamline less traumatic dressing practices (avoiding friction), use the Visual Analog Scale (VAS), use non-adherent products, and use analgesic medication ^(3,9,14).

Although the studies analyzed presented positive results regarding the management of neoplastic wound symptoms, care practice remains a daily challenge. The findings of this integrative analysis reveal that the generalist training of nurses, combined with a lack of ongoing training, the absence of specific training, and a scarcity of updated national guidelines, makes comprehensive care for malignant oncological wounds challenging, a condition that culminates in incorrect wound management, impaired decision-making, and poorly standardized care strategies ^(5,7,12).

Studies have shown that nursing professionals face recurring challenges related to limited knowledge about the specificities of oncological wounds, as well as difficulties in prescribing appropriate dressings for the stages and manifestations of these wounds ⁽¹⁵⁾. This lack is reinforced in the authors' studies ^(10,16), which complement this discussion by highlighting that a lack of specific knowledge ultimately leads to neglected nursing care and the promotion of imprudent practices.

Research has observed that nursing care demonstrated inadequate conduct in crucial areas of malignant neoplastic wound care, such as the prescription of inadequate dressings, and the use of essential fatty acids (EFA) to stimulate cell growth and healing, which consequently leads to tumor growth in the wound bed ⁽¹⁷⁾. Another concerning aspect observed in the studies is the lack of adequate materials and supplies for dressings and the absence of continuing education programs in healthcare institutions ^(7,10,16).

Studies conducted at a hospital specializing in oncological diseases in a municipality in southwestern Minas Gerais (MG) showed that the presence of a foul odor and recurrent bleeding were the main symptomatic manifestations of neoplastic wounds, which presented difficulties and barriers to the provision of care by the nursing team, as professionals' repulsion toward advanced tissue degeneration was observed ⁽¹⁷⁾.

In the home setting, the main challenges faced in the treatment of malignant neoplastic wounds include a lack of information among family members regarding appropriate wound care, a shortage of professionals qualified to perform the procedure, a lack of experience and specific training, limited material resources, and difficulty in continuity of care. These conditions ultimately increase the risk of complications such as bacterial infections and wound compromise ^(15,16).

According to the analysis process, the following limitations were observed in the studies: limited sampling and the absence of clinical trials or experimental studies. Furthermore, gaps were noted in the current literature regarding studies that addressed the emotional aspect of patients and professionals during the treatment of malignant oncological wounds.

FINAL CONSIDERATIONS

Given the facts presented, the need for ongoing training for nursing professionals is evident. This training is aimed at addressing the challenges posed by the complexity of managing and treating neoplastic wounds, as well as improving knowledge levels and updating current institutional protocols, aiming to establish comprehensive care and safer interventions.

This study is expected to contribute to healthcare practice by highlighting the need for standardized interventions and safer nursing practices tailored to the needs of wounds. It also highlights the potential for errors and inappropriate behaviors in the daily work of oncology nurses.

Finally, future research should explore more innovative treatment approaches and investigate the impacts of ongoing training for nursing professionals on the management of cancer wounds, the effectiveness of different types of dressings, patient- and family-centered emotional support strategies, and the management of neoplastic wounds in the primary care setting.

REFERENCES

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14. Starace M, Carpanese MA, Pampaloni F, Dika E, Pireli A, Rubino D, et al. Management of malignant cutaneous wounds in oncologic patients. Supportive Care in Cancer. 2022;30(9):7615–23. doi:10.1007/s00520-022-07194-0.

15. Lima TR, Lima MSFS, Carvalho ESSC, Paranhos RFB, Araújo IFM, Sousa AR, et al. Cuidados de familiares às pessoas com feridas neoplásicas malignas em domicílio. Estima. 2022;20:e1022. doi:10.30886/estima.v20.1222_IN.

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Funding and Acknowledgments:

This research received no additional funding from other sources.

Authorship Criteria (Author Contributions)

All authors: Marcos Carvalho da Silva1, Andreza de Oliveira Ribeiro2, Sthefani Santana dos Santos3, Monyse Ribeiro Souza4, and Josefa Raianne Peixoto5, contributed substantially to the conception, planning, analysis, and interpretation of the data; Kaique Maximo de Oliveira Carvalho6, approved and revised the final version of the manuscript.

Declaration of Conflict of Interest

"Nothing to declare."

Scientific Editor: Francisco Mayron Morais Soares. Orcid: https://orcid.org/0000-0001-7316-2519

Rev Enferm Atual In Derme 2025;99(3): e025108

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