Living with Skin Cancer

I’m a 39-year-old Australian with fair skin. As a youngster in the 70s, I spent all my days in the blazing sun, unprotected except on occasions when my parents took me to the beach. Nobody worried much about sun protection in those days, and skin cancer was not in the media like it is here today.

At age 22, I received my first diagnosis of skin cancer and was treated with cryosurgery to my lower lip (quite painful and caused scarring) and a few spots on my hands, nose and feet. The dermatologist told me that all the damage he was treating was caused by sun exposure in my childhood and teenage years. He said that “one peeling sunburn is enough to put you at risk of skin cancer for the rest of your life.” He also told me that I would need to protect all exposed areas of skin from the sun (any sun) for the rest of my life, and that I should see a dermatologist every year for a checkup.

I have followed both instructions to the letter for the past 17 years, but true to his prediction, the lesions keep appearing - sometimes solar keratoses, once a basal cell carcinoma that he had to surgically remove from my back, once a squamous cell carcinoma that he had to remove from my chest, and countless small spots from my nose and hands. There was also one more episode of cryosurgery to my lip, about 10 years ago now.

Now, in mid-2007, I’ve gone along for treatment for a solar keratosis on my lower lip, which I must confess, I let go for far too long before seeking treatment. This time, my dermatologist (a different one than before) ordered a course of treatment with Efudix cream (5-FU). She said I should use it for 3 weeks, each night, then use a healing cream called Newderm, the active ingredients of which are cod liver oil and retinol. As it turned out, most of my lip had these lesions on it.

In case anyone is wondering how I knew that these lesions were cancerous, or at least pre-cancerous, they were patches of dry, flaking skin that never went away, even though I always keep my lips moistened with some form of balm. The left-hand side of my lower lip peeled every week, large flaps of dry skin coming off at once. The rest of the lip was always dry, but I didn’t think it was as bad as it has turned out to be. Interestingly, Efudix only affects unhealthy cells - quite amazing. So pretty much my whole lower lip responded to the treatment, except for the outer margin, which has had two doses of cryosurgery over the years so the cells there are healthy.

I’m writing to give some advice to anyone who has to undergo this treatment to their lip. I feel there are a few things my doctor could have told me that would have made the treatment much more comfortable. I’m just glad I have a nursing background or I might have been even more uncomfortable than I have been for the past week or so.

1. Your lip needs to get to the point of ulceration; that is, the skin needs to become so irritated that it is raw and weeping. This is the process that will remove the damaged cells and allow new (hopefully healthy) cells to take their place. If your lip gets to this stage on day 9 of treatment, as mine did, you should ask your doctor if you can stop. My doctor had instructed me to use Efudix for three weeks, but in my case this was not necessary. If I hadn’t questioned her instruction, I think I would have been in a lot more pain than I have been. As it is, she agreed that I should stop the Efudix and start with the Newderm. So lesson one is: listen to your body. The doctor can only prescribe what is “normally” required. S/he cannot know how your individual body will react. Call your doctor if you have any concerns.

2. BUY SOME DRINKING STRAWS. Do not ignore this simple piece of advice. I put it off far too long and only bought them when my lip had already been ulcerated for five days. Every time I touched my lips to a glass or cup, the lower lip stuck to it, leaving behind unsightly lumps of goo and sometimes tearing my lip, causing bleeding. This is not good for healing skin. The skin needs that protective layer of serum for the time being.

3. Get yourself some very runny lip salve that you can blob generously onto both your top and bottom lips during the day, to keep them moist. Once your lip is at the ulceration stage, your top lip will be sticking to it, so that every time you want to part your lips for any reason (drinking, eating, speaking, breathing), it pulls on both the uninjured top lip and the injuries on the lower lip. After three days of this, I was going spare with the constant stinging, as my top lip had also become raw from it. The only thing that really feels good is the Newderm cream, but it’s only to be used once a day, in the evening (not the least, I guess, because it looks like white paint and never does go clear). I think pure aloe vera gel would be ideal for daytime use, but I haven’t been able to get any. Olive oil helped, but it’s very messy and needs to be reapplied every 20-30 minutes. You don’t want anything with tea tree oil - I tried this and it stung.

4. Make sure to eat plenty of fresh fruit and vegies and drink plenty of water or juice. Efudix is a form of chemotherapy even though it’s not administered intravenously, so your body takes a bit of a hit. If you read the package insert, it says not to get pregnant (for women) and not to cause a pregnancy (for men) while using it, so from that, I conclude that it “gets inside you”, as my Dad used to say. So make extra sure to support your body’s healing process with plenty of fresh, wholesome foods and drinks.

5. I’ve found it necessary to bathe my lip several times throughout the day, to remove the extra serum that builds up between the lips. Naturally, it’s more comfortable to do this at home than at work, so if you’re able to take some time off while you go through this stage, do so. I found that a day or two of not having to speak to anyone was very helpful, as it minimised the number of times in the day that I had to part my lips.

6. Whatever you do, DO NOT apply dry cotton pads or dry cotton buds to the ulcerated lip to remove the built-up gunge. It will stick and you’ll risk tearing part of your newly-forming skin to get it off again. Wet the cotton pad/bud till it’s dripping, and use that. Even then, be very gentle. You need to leave some of that stuff there to protect the new skin. You’ll know if you’ve gone too far, because it will hurt, and may even bleed.

7. Keep the scabs (i.e. dried serum) moist or you will risk splitting the new skin that is forming underneath. As the serum dries, it contracts, taking your lip with it. You’ll find yourself holding your lips in a pursed fashion. This is when you know you should go for some more moisture, because if anything makes you smile at this point, or if you sneeze or cough, a dry scab will crack and cause pain as it pulls on the tender new skin beneath it.

O.k. that’s about it I think. I guess most doctors have never actually had to endure this treatment, so they don’t know to tell you these things. When I go back for my follow-up appointment in a few weeks, I will mention these things to my doctor. Meanwhile, I hope this info is helpful to someone.