I think Efudix, the chemotherapy in a tube, isn't as readily available nowadays as it was in 2022.
In their letter giving me my diagnosis, the bots had mentioned the treatment was going to hurt and I needed to keep going for four weeks. Apart from that, I was on my own and it was up to me to work out how to take my first stumbling steps into the promised brutality of this particular baptism by fire.
I headed over to the New Zealand site suggested by the bots. It looked impressive and appeared to provide the sort of information a dermatological amateur like me needed to know. I guessed people in that bright and beautiful part of the world made good use of it.
The site described Efudix as "powerful" and "destructive" and cautioned that it "must be used exactly as directed". There's that word again. Directed. Also, in an instruction that proved highly controversial when I mentioned it to a doctor a few years later, the site emphasised the importance of application "to all the skin and not just visible lesions". This was apparently known as a 'field treatment'. It was obviously essential that I didn't miss any nasties. Finally, I was told "the maximum area to be treated at any one time" was "500 square centimetres". There were no instructions on how to measure a scalp so I hoped my head was compliant and left it at that.
I then had a good look around for suggestions about how to use it, the most useful of which was probably this: it should to be applied several hours before going to bed. This was important because it had to be fully absorbed to prevent it being inadvertently transferred onto pillows and bedding, and from there into my eyes.
I was good to go and my four weeks started in the middle of November. Yes, that's right, a month before Christmas. I had a pre-cancerous condition and wasn't going to delay its annihilation.
The first week went well. I was surprised to find the initial application only moderately painful. But I guess that's a relative term. If you've ever had a close encounter with paint stripper, as I once did when I got it on my hands, then that's what I mean by moderate. The rest of the week was pain free and nothing seemed to be happening (I expected this).
Things began to liven up towards the end of the second week. Still no pain but my scalp was definitely turning red, as promised. All good.
When the third week bared its cytotoxic teeth my scalp must have realised there was no contest and duly submitted without putting up much of a fight. In no time at all, reddening flesh became the colour of arterial blood and began to ooze and disintegrate into a mushy mess. I remember vague discomfort but no actual pain, as such. Moving in for the kill, the Efudix was mercilessly tearing off skin layer by layer. And with it, I hoped, the actinic keratosis.
This disgusting process continued throughout the fourth and final week until, at last, it came to its sudden end. I'd done my 28 days before the mast and it was time to stop. That was it. Finished.
And to my amazement when fireworks celebrated the arrival of 2023 a couple of weeks later my scalp looked brand new (which I suppose it was).
