Efudex and Me: The Cold, Hard Truth
In 2007, I was diagnosed with melanoma upon removal of a suspicious spot on my left upper arm. The following years saw three Mohs surgeries for basal cell carcinomas and more precancerous cells burned from my chest, neck, and face than I care to try to count. As many people diagnosed with skin cancer quickly learn, there is no quick fix or ultimate end to the recurrence of precancerous spots. In 2012, my dermatologist began to review alternatives to cryotherapy (the freezing of spots with liquid nitrogen), as each of my checkups revealed numerous new spots. Eventually, I had my first encounter with Efudex topical cream.
Efudex, Fluorouracil, and 5-FU: topical chemotherapy creams
For the first time in 2014 I used Efudex (fluorouracil), a topical chemotherapy cream designed to bring abnormal, and possibly precancerous cells, to the surface and remove them over the course of treatment. My dermatologist chose to have me treat my chest specifically due to the sun damage I had incurred over many years tanning both outdoors and in tanning beds. During the years following the excision of my melanoma, I regularly saw my dermatologist and became more aware of my skin, the appearance of new spots, and any changes in moles. I was able to tell before each visit if she would have to freeze spots from my chest because I could feel tiny specks no bigger than a grain of sand on my skin. On occasion, these little flecks would sting, break free, and sometimes bleed slightly in the shower. These numerous spots of abnormal skin growth are precisely what the Efudex treatments are designed to combat.
Applying Efudex topical cream
Application of Efudex topical cream is a simple process--using a clean cloth and applying a thin layer to the treatment area once or twice a day. The effects of Efudex on the skin and the rest of the body differ greatly by patient and, for many, are not so simple. After beginning yearly treatments on my chest, I joined a Facebook group for users of Efudex. Speaking with other users and comparing notes and photos of our treated areas, I quickly learned two things.
- Physicians often do not know how individual patients will react to Efudex.
- The side effects are wide-ranging in both type and intensity.
My first year using Efudex, I applied the cream to my chest twice a day for four weeks. As the days went by, itching and burning intensified as my skin became increasingly irritated. Most sources direct users not to clean the skin between applications--I didn’t. (I have found this advice also varies by dermatologist). The treated skin drew tighter and split open in places after about three weeks. The skin began to separate and would bleed when it dried after applying Efudex. This is called the erosion phase. In addition to the cracking, some areas of skin turned darker and peeled leaving open, oozing spots. At this stage, wearing any clothing across the area of treatment becomes almost impossible. Fabric of any kind stuck to the seeping area and caused horrible pain when pulled away from the skin. During these weeks, I found it difficult to sleep and experienced some stomach upset.
The healing stage was harder
As trying as these four weeks sound, the healing stage was much more challenging. Efudex topical cream, for all the havoc it seems to cause on the surface of the skin, soothes the skin when applied. In a way, it was a relief to apply it as it temporarily calmed my itching and burning. Once I stopped application, my skin began to beg for the cream. It became more irritated. The seeping and peeling increased, and I was able to peel off soft chunks in the shower. The new skin beneath was tender and remained red and tender for several weeks.
My second year with Efudex was completely different. I only had reactions and itching and burning in a few spots, and had very few side effects. My third year was far worse than my first. Whereas most people are told that the 24-72 hours after stopping application would be the most difficult to endure, I wasn’t able to sleep regularly, work, or function well for over a week. Each of my chest treatments has been unique.
Keeping a journal during Efudex treatment
In June of 2017, my doctor detected some slightly scaly spots on my nose I never noticed myself. In addition, I had two round, red, scaly patches on my cheek and beside my nose. He asked me to treat my nose and the area around my mouth with Efudex topical cream. This was my first time to treat my face. I decided I would keep a running journal of my symptoms to compare to the next treatment.
How well have your skin cancer diagnoses been explained to you?