Efudex - does the effect spread wider than where it is applied?

Hi Greyowl

My husband was prescribed Efudix for an area of Bowen's disease that he had on his leg but the reaction only took place where he applied the cream.

If you click on this link it will take you to information about the cream including side effects. As far as I could see it didn't mention anything about reactions happening away from the site that you're applying the cream.

Have you started the treatment yet?

x

Thanks. Perhaps I had misunderstood earlier what I read about people applying it to their face - perhaps they applied it wider than there were symptoms. Or might it be different on the face?

No I haven't started any treatment. My first meeting with the dermatologist was terrible with no information or discussion, and having recommended cryotherapy immediately followed (after just 2 weeks) by Efudex he then changed his mind and refused to offer any treatment at all.

I have had this spot for at least 20 years, it is near my eye and although 'only' superficial bcc it can have spread under the surface.I have been scheduled to see someone else but must wait until the end of the month. Since having the symptoms I haven't had the opportunity to discuss it with anyone at all - because of the pandemic my GP referred me on the basis of a photo only, then the dermatologist looked at it but wouldn't discuss it all and just said I should have a biopsy, and now this last appointment contained no discussion either. So I feel I am in the dark still.

Hi Greyowl

I don't think the cream would react any differently on your face than anywhere else on your body. Maybe the reaction happened over a larger area because the BCC was more extensive than they realised, but that's just my best guess.

Thanks very much for taking the time to complete your profile. I can see from that you've had a punch biopsy which confirmed a BCC. 

I'm sorry to read that you had a bad experience with both dermatologists you've seen culminating with the last one refusing to treat you. I hope that at least he was able to explain why he couldn't treat you.

Since being diagnosed with melanoma 4 years ago I've seen quite a few consultant dermatologists and have found them willing to answer any questions I might have. I think sometimes they can forget that what is an everyday occurrence to them might be completely new to us. Sometimes I've had to ask my question again or ask them to explain something in layman's terms but they've always been helpful.

I know when I first went to see a dermatologist with the lesion on my arm that I was concerned about there wasn't much in the way of a discussion as such. He examined it using a dermatoscope, asked questions along the lines of how long I'd had it, etc and then said that he'd need to remove it and send it off for a biopsy to find out what it was.

What sort of things did you want to discuss and is it something that we might be able to help you with in the group?

x

Thankyou for your reply.

I must have been very unlucky with my appointments. It was the same dermatologist both times. He's never asked me a single question, and has barely said anything without me dragging it out of him. I didn't mind before the biopsy, but now I have the diagnosis I did expect a discussion of some kind. But in fact not only that, but he did not even describe the treatment he'd decided on (cryotherapy) and didn't explain the benefits or side effects. He'd nearly started on me (got me into position etc) before he remembered I hadn't signed a consent form. The form asked me to confirm I'd received information about the treatment, which I hadn't so I asked for it, and when I started to read it he suddenly announced he wasn't going to treat me. So no, he didn't tell me why he wasn't going to treat me except that I 'wasn't happy'. Despite the fact that I did sign the consent form. He clearly thought I was a very difficult customer.

The feeling I have is that my diagnosis is a bit too much in the middle of things. It's 'only' superficial bcc, so not so threatening and it doesn't have to be treated with surgery, but it is near my eye, and is spread beyond the limits of the biopsy - they obviously don't know how far. I was fast tracked because of the position of the bcc. I wouldn't mind so much them just having a go at it with whatever treatments are easy to try, but this scarring will be right in the middle of my face.

I've read that it is less common to have on the face, so they are usually dealing with this relatively easy bcc on a less 'sensitive' part of the body. I'd hoped that someone reading the forum might have had the same thing to hear what treatment was suggested on the face. I'm just surprised how casual the whole treatment process has been so far when I have been feeling really anxious about the outcome and also the impact of possible treatment.

I started a thread asking about the specific treatment he had suggested but there haven't been any replies. I'd not read anywhere of someone having cryotherapy and then only two weeks later applying Efudix to the same area. From what I have read that sounds almost impossible, because of blistering - he wouldn't discuss my worries - he said there wouldn't be blistering with the cryotherapy (but the information leaflet said there probably would...).

I will be seeing someone else in a few weeks. Hopefully he will be better to deal with but I am nervous about it now and don't know what it is ok to ask or expect - having been made to feel like I shouldn't be asking anything.

Greyowl

Of course you should be able to ask questions about your treatment and hopefully the new dermatologist will be happy to answer any of your questions.

I've just had a count up and I think I've seen 6 different consultants and 2 registrars and they were all fine, so I think you've been unlucky and, fingers crossed, you've just met the one horrible consultant in the NHS!

It's natural to worry about possible scarring on your face and the consultant would be taking that into account when they recommend what treatment would be best. I have a 6 inch scar on the back of my arm, although it is very feint now, but I wouldn't want that on my face if it could be avoided so I totally understand where you're coming from.

I've had cryotherapy for an actinic keratosis and it immediately formed a blister where it was applied (on my chest). The blister went down after a few days and the treatment had the desired effect. You said that you were worried about starting the Efudix only a couple of weeks after having cryotherapy but, from memory, I think my skin had healed in that time and I would assume that if it hadn't healed you would be advised to wait until it had. However, that's a bit of guess work so a question to ask the new consultant you're seeing.

There are literally hundreds of posts in this group from people who have had treatment for a BCC on the face. If you type 'BCC on face' into the search bar in this group you could have a read through some of them and reply to any of the more recent ones if you want to ask the poster a question. I say reply to the more recent ones as, unfortunately, most people tend to leave the group once they've had their treatment. Anyone who's posted in the last 12 months may still be around.

Let us know how you get on

x

Thanks very much for that, and good to hear you understand my worry about a facial scar. That was interesting about the cryotherapy, that the blister came and went quickly. Here's hoping my next appointment is calmer.

Yes I know lots of people on the forum have had bcc on the face, but they haven't had (as far as I have been able to find, and I have been sifting through all of them)' superficial bcc' on the face, and therefore they have mostly(all?) been treated with surgery. It seems that superficial bcc is the only one they would start off avoiding surgery.

Hi Greyowl

I've had a search for people who mention superficial BCCs on their face and found these posts for you to have a look through. Hopefully some of them may give you the information you're looking for. I'm 'tagging' into my reply to you as they only posted 3 days ago about having a superficial BCC on their face so hopefully they'll pop in and tell you all about their experience.

x

Thanks very much Latchbrook. Trawling through all of these I found 5 or 6 that are about superficial bcc (the word superficial pops up in other contexts, and 'Sbcc' is usuall squamous bcc!).  I found only one description of treatment there but it was helpful to read it. I will have to wait for my 'second opinion' appointment to get some clearer advice.

Hi, just seen I’ve been tagged. I’ve had a tiny 2-3mm spot under my eyebrow, not yet received histology but specialist thinks tiny superficial bcc. I chose curettage above cream to get rid of it. This decision was based mainly on him saying that I’ll heal and it’s like a graze. I hope you get better treatment than you e had so far. I had to go private due to a catalogue of errors over a scalp bcc (see my other posts) then I had another on my leg, now this under  eyebrow. No more!!

Thanks. It sounds like you've had a really hard time, I'm sorry to read about all the difficulties, by the sounds of things mostly not with superficial bcc but other kinds. The superficial bcc I have is larger than the one you had curettage for. I've no idea what will be suggested for me as treatment, it's all very confusing so far.