A 90-year-old male patient was referred to the Emergency Unit because of a malodorous, bleeding scalp ulcer. His medical history was positive for colon carcinoma, B-cell chronic lymphocytic leukemia treated with bendamustin, field cancerization on the head, tumor-associated anemia, thrombopenia, gluteal pressure sores grade III and acute urinary tract infection.

On physical examination we observed a large scalp ulcer with living organisms (Fig. 42.1). After mechanical removal of the maggots a clean ulcerated tumor was presented (Fig. 42.2).

Fig. 42.1
figure 1

A scalp ulceration with living animals

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Fig. 42.2
figure 2

A clean wound after maggots’ removal

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Based on the case description and the photographs, what is your diagnosis?

FormalPara Differential Diagnoses
  1. 1.

    Myiasis.

  2. 2.

    Neuropathic ulcer.

  3. 3.

    Leishmaniasis.

  4. 4.

    Ulcerated squamous cell carcinoma.

  5. 5.

    Secondary cutaneous B-cell chronic lymphocytic leukemia.

FormalPara Diagnosis

Myiasis on squamous cell carcinoma.

Discussion

Maggot therapy or biosurgery has become a regular medical treatment at the beginning of the last century but was forgotten after invention of antibiotics. The treatment has gained a renaissance around the turn of the last century to clean necrotic wounds with biofilms, such as diabetic foot ulcers or pressure sores [1].

In the present patient, infestation with maggot was accidental. This is called myiasis. Myiasis with maggots bears a risk of secondary bacterial infections including sepsis and bleeding. Maggots that feed from vital tissue can cause significant tissue damage, inflammation and pain [2]. Myiasis of skin cancer has rarely been reported [3]. The maggots should be removed mechanically to avoid further bleeding and infection [4, 5].

Due to the bad general condition of the presented patient, no treatment for squamous cell carcinoma was introduced and the further treatment was palliative only.

Key Points

  • Myiasis is an infestation with maggots.

  • Maggots may cause bleeding, inflammation and secondary bacterial infections. Therefore, they should be mechanically removed.