Objective To search, evaluate and integrate the best evidence regarding symptoms management of malignant fungating wounds, to provide a practical reference for clinical practice, to improve wounds symptoms in patients with malignant tumor and improve patient quality of life. Methods We searched such databases as Guidelines International Network(GIN), National Guidelines Clearinghouse(NGC), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network(SIGN), Registered Nurses′ Association of Ontario, China Guidelines Clearinghouse, UpToDate, JBI, CNKI,etc., for high level evidence on symptoms management of malignant fungating wounds published from inception of the databases through December 2019. Results A total of 15 literatures (2 guidelines, 1 clinical decision report, 3 evidence summary reports and 9 systematic reviews) were included. Eleven aspects, which included wounds assessment, the selection of assessment tools, wounds cleaning, wounds debridement, wounds dressing selection and use, odor management, exudate management, bleeding management, pain management, itch management, and nutrition management, were extracted from 48 pieces of best evidence. Conclusion The best evidence regarding symptoms management of malignant fungating wounds can provide a practical reference for clinical medical staff. Medical staff need to consider clinical environment of the unit before applying the best evidence to manage the symptoms of malignant fungating wounds scientifically, which could improve the quality of life of patients.