Why I Say “No Thank You” to Efudex

I may be in the minority with my approach to skin cancer treatment, but I have my plastic surgeon to thank. He treated my skin cancer for over twenty years, up until his retirement. He was an excellent plastic surgeon who specialized in skin cancer treatment. While he encouraged me to regularly see a dermatologist (I was a bit lax in regular appointments in my early years of skin cancer, as I naively didn’t think it was a big deal after just one basal cell area), our care plan for me was that if I had any precancerous areas (typically called actinic keratosis or AK) spotted by the dermatologist, those would be treated by her, most likely by freezing the area. My plastic surgeon would remove any skin cancer areas I may have, either by excision or laser surgery. I had a few, but not many, precancerous areas that needed freezing over the years.

New dermatologist pushed Efudex

My plastic surgeon was not a fan of Efudex or other chemo creams that some doctors recommend, and upon doing my own research on the creams, I agreed with him. After my dermatologist moved out of state, I had a new-to-me dermatologist strongly recommend that I use Efudex to “get rid of what may be hiding under my skin”. She downplayed quite a bit what I could expect from using Efudex, saying that there may be a little discomfort but that it wasn’t too bad. She also failed to mention that some people are recommended to have repeated treatment, sometimes every year (or more often). That dermatologist told me that Efudex was great for treating any actinic keratosis areas people may have.

However, I learned in my research that at most, 10% of AK turn into cancer, which means that 90% or more do not. Some AKs will never develop into anything else, and some AKs go away without treatment.1 AKs do not turn into melanoma, and “the vast majority of actinic keratoses remain benign”, according to The Skin Cancer Foundation.1

Knowing the risk Efudex can have on pets

There’s no question that using Efudex can be hard on a person. I’ve read many stories, both in our community and online as well, about the nausea and light sensitivity that are also part of Efudex treatment, in addition to the pain and discomfort. I also discovered a warning about Efudex usage that isn’t widely publicized: Efudex can kill your pets. The Food and Drug Administration has warned pet owners that dogs, cats, and other animals may die if exposed to skin cancer creams that contain fluorouracil, commonly sold under the names of Carac, Efudex, and Fluoroplex.2 If you apply the cream with your hands and then touch your pet, or your pet licks an area where you have applied your cream, or your pet comes into contact with a cloth or applicator you used to apply the cream, or there is residue from the cream on your clothes, carpets, floors or furniture that your pet ingests, it could be fatal to your pet.2 Extreme caution should be used during Efudex treatment to keep it completely away from pets.

My decision to say “no thank you”

For me, using a chemo cream that will cause such discomfort and pain to treat something that may not even materialize, to take a month or more to heal from that after applying it for a month, and then to have to do it again in a year (or more often), isn’t something that I want to do, which is why I told that particular dermatologist “no thank you.”

I do realize that everyone is different, and skin cancer affects us differently. Your skin cancer is your cancer, and you have the right to have a say in your treatment options. If your doctor has recommended Efudex and it works well for you, that’s awesome. If you have tried it and found it doesn’t work well for you, or if you are hesitant about having that particular treatment, know that you have options. Research your options and find a doctor who will work with you in your care plan. This will go a long way in your battle with skin cancer.

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