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Skin Cancer Treatment

Written 5th November 2020 - Last Update 17th August 2026

Skin Cancer Treatment

5-Fluorouracil 5% Cream (Efudix)

Inidications:

  • AK

  • Bowens Disease

Contra-indications:

  • Pregnancy & Breast-feeding

  • (Active) Inflammatory skin conditions (eg rosacea)

Side Effects:

  • Burning / Stinging / Pain

  • Reddness

  • Ulceration

  • Crusting

  • Photosensitivity

  • Weeping

  • Contact Dermatitis

  • Itch

  • Hyper/Hypopigmentation (infrequent)

  • Scarring (infrequent)

Dosage:

  • AK

    • Once or twice daily for 2-3 weeks

    • Until marked inflammatory response

    • Facial lesions respond more quickly

  • Bowens Disease

    • Min 6 weeks

    • May require occlusive dressing

Counselling:

  • Avoid Sun exposure

  • Wear Broad brimmed hat if in sun

  • Do not apply sunscreen to ares where cream is being used

  • Apply with glovers or non-metal applicator

  • Do not allow to get on cut skin or mucus membranes

  • Do not apply immediately before going to bed (give 1.5-2hr) gap

    • To avoid it rubbing off on sheets, then going to other places

Imiquimod (Aldara):

Indications:

  • External genital or perianal warts

  • Superficial BCC

  • Actinic keratoses of the face and scalp

Contraindications:

  • Marked hyperkeratosis/hypertrophy (e.g. cutaneous horns)

  • Lesions within 1 cm of eyes, nose or lips

  • Immunosuppression (e.g. HIV, abnormal blood count, immunosuppressive medications) — discuss with a dermatologist first

  • Lesions previously treated with imiquimod that failed to clear

  • Pregnancy and breastfeeding

Dosage (actinic keratosis): apply at night, then wash off in the morning with mild soap and water — usually 3 times a week for 4 weeks. Treated area should not exceed 25 cm × 25 cm at a time; treat larger areas in sections. Assess response at 1 week for first-time users; reduce dose if an intense reaction occurs. Review at 1 month; if lesions persist, repeat a 4-week course (maximum 2 courses).

Efficacy for actinic keratosis: complete clearance in 48–57% of patients; partial (>75%) clearance in 64–72%.

Common side effects: local skin reactions lasting up to 4–8 weeks, flu-like symptoms, post-inflammatory hypopigmentation. Consider dermatology referral for supervision through the first course if reactions are likely to be extensive.