When the 'little Guys' (on Your Skin) Keep Coming Back

Time to brush up on your Greek mythology, which, believe it or not, will tie into skin cancer treatment and prevention. Do you remember Sisyphus? The king of Ephyra (Corinth) was a cunning and deceitful person. He so angered Zeus with his trickery, that the king of the Gods came up with a terrible punishment. He condemned Sisyphus to eternally push a boulder uphill in the underworld… and watch the boulder roll right back down. He would push it back up, then down it came, and so on and so forth.¹

A Sisyphean task is one that can never be completed, or a task that is endless and ineffective, requiring continual effort. Something Sisyphean (or Sisyphean, pronounced \sih-SIFF-ee-un\), according to Merriam-Webster, “demands unending, thankless, and ultimately unsuccessful efforts.²

How this relates to my skin cancer

It is not an exact parallel, but I sometimes feel that trying to banish the actinic keratosis from my right forearm is a Sisyphean task. I treat the area with a combination of calcipotriene (Dovonex, a form of Vitamin D that induces an immune response) and 5-fluorouracil (Efudex, a chemotherapy cream). The flaky spots turn red and irritated and disappear. I have not tracked how long it takes for them to come back. But it seems like, in the blink of an eye, they are back. And I need to treat them all over again. I imagine it has some benefit of preventing the spots from turning into squamous cell carcinomas. One of my doctors calls the spots little guys. Maybe the cream prevented the old little guys from turning into skin cancer and the ones coming up are new little guys. But just the fact of having to retreat the whole area feels like a Sisyphean task.

My medical team

Enter two dermatologists, Dr. Liu, my regular dermatologist, and Dr. Schmults, the Mohs surgeon who treats high-risk patients like me. Dr. Schmults gets the final word. When I saw Dr. Liu recently for a checkup, she said she thought the Dovonex was diluting the Efudex. She said I should retreat with Efudex alone. This made me sad. The combination cream therapy is much shorter, around five days, than Efudex alone. The duration for applying Efudex can be four weeks or longer (or shorter), depending on your reaction.

There was some talk of me getting the two creams in one from a specialty compounding pharmacy. It is sold under names such as “FU/Cal.” But it is expensive and apparently not much better than doing it myself. I briefly thought of doing it because you’d think the ratio of creams would be more precise. I think one of my doctors even wrote and sent a prescription for it. But nothing ever happened, and I forgot about it. Shortly after my visit with Dr. Liu, I went to see Dr. Schmults for Mohs surgery on a tiny squamous cell cancer on my neck. That is another story. It was so small I thought (and hoped) that the biopsy might have taken care of it. I didn’t see any sign of it. But she found the location… and off it came. The thought of it was worse than the actual thing. It wasn’t bad at all.

My Sisyphean task

I asked her about my Sisyphean problem. She said I WAS diluting the Efudex, but not in the way that I thought. She asked how I applied it. I said I mixed it in my hand. Apparently that’s now how you do it. Who knew? Nobody ever told me. She said to apply the Efudex first and let it dry, and to then go back and apply the Dovonex. This takes more work and more time while you are doing it. But it is preferable to Efudex alone due to the length of time required. Something else I didn’t know is that the arms take longer than the rest of the body. I am currently treating the backs of my calves and some areas on my face AND the arm. I can stop the other areas after five days but need to do the arm for about 12 days. The new system will take longer, but hopefully the darned little guys will stop coming back. It would be nice to no longer feel like I am doing a Sisyphean task.