Malignant fungating wounds (MFWs) arise in 5–10% of all cancers. These wounds are distressing for patients, their families and caregivers, with both physical and emotional symptoms impacting greatly on quality of life. Symptoms include severe pain, bleeding, depression, malodour and negative body image. MFWs present considerable challenges in the application and retention of dressings. These wounds deviate from the normal healing trajectory and the theory of wound healing is not always appropriate; they may expand and progress during the terminal stages of a patient’s life. This article discusses the challenges of treating and managing MFWs and presents some practical solutions to the major symptoms. It also looks at dressing choice and pain management — including pharmacological and topical treatments — managing malodour, as well as assessing and addressing quality of life.