TREATMENTS
Topical medication for skin cancers & solar keratoses
Topical treatments are a relatively low-scarring and inexpensive way to treat some skin cancers and sun damage.
- Superficial (thin) skin cancers can be cured with topical treatment
- Less painful than freezing large numbers of solar keratoses
- Reduce the risk of future skin cancers in the treated area
People with many solar keratoses may get better results from applying a cream to affected areas rather than treating individual spots. This is known as field treatment. This type of treatment can eliminate subclinical (invisible) spots, and the recurrence rate is lower than with individual spot treatment.
Some patients with skin cancers prefer to avoid surgical treatments due to concerns about scarring, discomfort, downtime and expense. In these cases, topical treatments are a valuable option as long as the skin cancer is amenable to treatment in this way. (A biopsy is usually necessary to make sure the cancer is thin and can be successfully treated from the surface without requiring a full-thickness skin excision.)
Combination medication: “Efucal”
Combining two medications into a single product is a relatively new way of treating solar keratoses and Bowen’s disease:
- Fluorouracil: An antimetabolite (kills cancerous and pre-cancerous cells), and
- Calcipotriol: An immune modulator (stimulates the production of TSLP, which has an anti-tumour immunity effect).
This combination is not commercially available and must be prepared by a compounding pharmacy. For convenience, skin cancer doctors sometimes refer to this combination as “Efucal” or FU/Cal.
MBBS, MA (Virtual Comm), Grad Cert Hlth Info, Grad Dip Comp Inf Sci
| Location/indication | Duration |
|---|---|
Solar keratoses of the face, chest and scalp |
Twice daily for 4-6 days |
Solar keratoses of the lip |
Twice daily for 2-4 days |
Solar keratoses of other areas, e.g. hands, forearms, legs |
Twice daily for 6 days |
Bowen’s disease |
Twice daily for 6 days. 14 day break. Twice daily for a further 6 days. Note: further treatment may be required depending on treatment response. |
Application instructions
- Wash the skin to be treated using lukewarm water. Avoid soap which may sting or irritate your skin, especially as treatment progresses.
- Pat dry the affected area.
- Allow your skin to completely dry.
- Apply a thin layer of cream to the affected area(s)twice a day, without a dressing, for the time advised by your doctor. Do not continue further unless advised by your doctor.
- Use a non-metal applicator, cotton bud or a rubber glove to apply a thin film of cream to your affected skin. Use the smallest amount that can cover the treatment area.
- Don’t allow the cream to contact mucous membranes, such as eyes, eyelids, nostrils and lips, unless your doctor has advised you to treat these areas.
- Do not apply to broken skin or open cuts as it may be absorbed into the bloodstream and may cause side effects.
- Wash your hands carefully and thoroughly immediately after using the cream.
- Do not cover the treated area unless your doctor tells you to.
Apply in the morning and then again in the late afternoon or early evening. Do not apply the cream immediately before going to bed. Apply at least 1.5 – 2 hours before bedtime to enable complete absorption and prevent wiping off on to pillowcases and sheets. Contact with pillowcases or sheets may cause spreading of the cream to normal skin that does not need treatment.
The total area of skin treated with at any time should not exceed 500 cm² (approx.23 x 23cm). Treat larger areas a section at a time.
Conditions treated
Side effects and warnings
These medications are not safe to use during pregnancy and when breastfeeding.
They can be very irritating to the skin, although in most cases, the irritation is mild. The treated area appears unsightly and may be uncomfortable during treatment and up to 2 weeks after the course is completed.
Avoid known photosensitising drugs and chemicals before light-based treatments such as laser, IPL/BBL and LED light therapy. If you are taking these medications, be sun smart every day.
More infoCold sores are a known side effect of surgical, laser and IPL treatments. You can reduce the risk by taking antiviral medication before treatment, or immediately if you notice the onset of cold sore symptoms after your treatment.
More infoRedness, swelling, blisters and sores are often a common result of aesthetic and skin cancer treatments. In most cases, they can be managed easily and settle gradually over the following weeks. However, it’s important to notify the clinic if you are very uncomfortable or concerned about your reaction being abnormal.
More infoAftercare
Irritated skin may be itchy or painful. There may be a burning sensation, redness and ulcers or sores in the treated area. Sometimes these symptoms affect areas that did not previously have solar keratoses. This means that the ingredients are treating sun damaged skin that has not yet developed into solar keratoses or skin cancer.
If symptoms are severe, paraffin ointment/petroleum jelly (e.g. E45, Bepanthen, pawpaw ointment, Vaseline, Aquaphor or Infadolan) can provide relief.
Inflammation and redness usually settle in 2-3 weeks. However, a course of low-level light therapy, which reduces inflammation and redness following surgical procedures and skin injuries such as burns, may reduce this time. This treatment is available at Spot Check Clinic.
Do not use antiseptics such as Betadine, as they tend to dry the skin and make irritation and pain worse. If you suspect that the skin has become infected, notify your doctor.
In unusual cases, more general side effects can occur. These include fever, dizziness, abdominal pain and cramps, diarrhoea and vomiting. If you experience these symptoms, stop using the medication and notify your doctor.
More information
Under Australian legislation, medical practitioners can’t publish information about prescription medications. We recommend these sites for more specific information about the medicines on this page:
- 5-fluorouracil 5%, calcipotriol 0.005% topical cream from Artisan Compounding Chemist
- Efudix consumer medicine information from NPS MedicineWise
- Aldara cream 5% consumer medicine information from NPS MedicineWise
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